“It's Been Hard, but I Know That I Can Do It Now. I Know That I Can Stay Housed”: Perspectives of Community Mental Health Clients on Skills and Strategies to Maintain Stable Housing

Background and Purpose: Social skills training (SST) uses motivational and behavioral strategies to improve social functioning, self-efficacy, and psychiatric symptoms among adults with serious mental illness (SMI). Social functioning refers to a person’s ability to navigate the social environment to meet relational, occupational, and everyday needs. Profound structural barriers and personal difficulties can impede unhoused adults in meeting these basic needs. Apart from the Veterans’ Affairs Health Services, few studies have sought to tailor SST for unhoused adults served in community-based settings. This study seeks to inform the development of housing-focused SST by understanding the skills and strategies used by formerly unhoused adults used to attain stable housing.

Methods: We used a purposive sample of stably housed adults who self-reported any history of homelessness and mental health or substance use difficulties (N = 24). Participants were sampled from permanent supportive housing and community mental health agencies in a Midwestern US state. Before the interview, the interviews explained the study purpose and collected informed consent. The interviews lasted 40 minutes, occurring in a private setting at a time convenient for participants. The COM-B model for behavior change to guide our rapid qualitative analysis. After transcribing audio-recorded interviews, we piloted the interview summary template to standardize data extraction. Matrix analysis was then conducted to generate themes.

Results: The sample (N = 24) had a mean age of 45 years (SD = 13) and identified primarily as men (58.3%). Participant-reported racial/ethnic background included Black (50.0%), White (33.3%), or multiracial or other races (16.7%). One-quarter of participants identified as a member of the LGBTQ+ community. When unhoused, participants reported experiencing limited social opportunities to maintain social competence or develop new skills due to social exclusion and being in unsupportive environments. Despite these socioenvironmental barriers, participants discussed several motivational processes that were instrumental for securing and maintaining housing, such as determination, patience, and valuing oneself. These motivational factors facilitated the acquisition or use of skills such as learning to ask for help in diverse contexts, such as to better understand the terms of a lease or secure resources after moving to a new neighborhood. Enhancing communication skills such as assertiveness, disclosure, and expressing negative feelings were emphasized as necessary for securing employment, navigating conflict with neighbors, clinicians, or property managers, or reconnecting with friends or family. Participants highlighted the benefits of learning to use leisure time well, describing activities of self-care and of giving back to the local community through formal and informal volunteering and faith-based activities that provided new opportunities for connection and meaning.

Conclusions and Implications: People with experiences of homelessness and SMI report a diverse range of skills and strategies for securing and maintaining stable housing. Findings offer relevant insights for tailoring SST to support social functioning and housing stability among adults with SMI who have experienced past or recent episodes of homelessness.