Social inclusion and supported housing: A qualitative exploration of residents with co-occurring challenges and staff experiences

Abstract

Background: The promotion of social inclusion among persons facing co-occurring mental health and substance use challenges (i.e., co-occurring challenges) is an important aim. Despite the policy endorsement in Norwegian guidelines for mental health and substance use services for promoting social inclusion, persons with co-occurring challenges face greater challenges in experiencing social inclusion than the general population does. In Norway, some persons facing co-occurring challenges reside in supported housing. While the provision of supported housing is assumed to contribute positively to the goal of social inclusion, there is a need for more knowledge regarding residents’ experiences with social inclusion. Specifically, two dimensions of social inclusion, namely a sense of belonging and social participation, have been recognized as core issues deserving attention. Knowledge is also needed about staff’s experiences with promoting social inclusion for residents. While the literature on staff’s experiences in promoting social inclusion for residents appears to be scarce, scholars have emphasized the need to understand the role of economics in promoting social inclusion.

Aims: This project aimed to develop scientific knowledge that can contribute to the promotion of social inclusion, specifically focusing on a sense of belonging and social participation for persons with co-occurring challenges living in supported housing. The current project was conducted as part of a parent research project that aimed to promote recovery and recovery-oriented practices in supported housing. Social inclusion is widely recognized as a pivotal element in a person’s recovery process. In this project, residents’ experiences of social inclusion and the experiences of staff in promoting social inclusion for this group were explored and described. Furthermore, findings from published qualitative research addressing social inclusion for this group were systematically identified and analyzed. The current project consists of three studies. Study 1 aimed to explore and describe residents with co-occurring challenges sense of belonging to the supported housing site and the community context. As well as staff’s experiences promoting residents’ sense of belonging within and outside the housing site. Study 2 aimed to explore and describe staff’s experiences with promoting social participation for residents with co-occurring challenges. The study focused on how economics (i.e., financial resources) influenced staff’s efforts. Study 3 aimed to synthesize findings from qualitative studies that addressed social inclusion in a supported housing context from the perspectives of residents with mental health and/or substance use challenges.

Methods: This project was influenced by critical realism and person-centered theory. Two research designs were employed: a qualitative collaborative research design for studies 1 and 2, and a qualitative meta-synthesis design for study 3. Study 1 consisted of five individual interviews with residents facing co-occurring challenges and a focus group interview with nine staff members. Study 2 comprised a focus group interview with three staff members and individual interviews with six staff members. The individual interviews were done in-person or over the phone. The interviews in studies 1 and 2 were analyzed using reflexive thematic analysis. Participants in studies 1 and 2 were recruited from a single congregate supported housing site in a large city in Norway. An advisory group consisting of residents and staff from the supported housing site, along with researchers from the parent research project, were involved in the research process of studies 1 and 2. In study 3, a systematic literature search was performed in six databases. The meta-synthesis included fourteen papers, from which the findings were analyzed using qualitative content analysis.

Findings: The findings reported in paper 1 demonstrated how the social environment within supported housing influenced residents’ sense of belonging and staff’s efforts to promote a sense of belonging. Furthermore, it demonstrated how experiencing a sense of belonging was connected to being able to make a choice. The findings presented in paper 2 outlined how limited financial resources constrained the staff’s capacity to promote social participation in the community context. Moreover, the prevailing impression among staff members is that municipal officials exhibited a reluctance to provide sufficient financial resources for the promotion of social participation among residents. The findings in paper 3 describe three core dimensions of social inclusion: having access to core resources, actively participating oneself, and being existentially anchored.

Conclusion: The findings in this project demonstrate the necessity of establishing basic resources to promote experiences of social inclusion in supported housing and community settings. Basic resources include securing a safe living environment, facilitating staff support, establishing a broad social network, and securing adequate financial resources. Balancing the responsibility of promoting social inclusion, which included active participation from residents themselves, and active support from community members, was important for promoting experiences of social inclusion in supported housing and community settings. The findings in this project call for further research exploring ways to establish basic resources, such as a safe living environment, staff support, a broader social network, and adequate financial resources. As well as the need to explore people outside of the healthcare sector's attitudes towards promoting active support to promote experiences of social inclusion for residents with co-occurring challenges.