Mothers with mental illness experiencing homelessness: a critical analysis

Intersectionality in nursing research: A scoping review

Background

An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants.

Objective

This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision.

Design & Methods

Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research.

Results

The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years.

Conclusions

Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.

Lived Experiences of Persons with Chronic Schizophrenia Living in the Community

Background

Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice.

Method

We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants.

Results

Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives.

Conclusion

Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.

Personal recovery and socio-structural disadvantage: A critical conceptual review

Despite its seeming breadth and diversity, the bulk of the personal (mental health) recovery literature has remained strangely 'silent' about the impact of various socio-structural inequalities on the recovery process. Such an inadequacy of the empirical literature is not without consequences since the systematic omission or downplaying, at best, of the socio-structural conditions of living for persons with lived experience of mental health difficulties may inadvertently reinforce a reductionist view of recovery as an atomised, individualised phenomenon. Motivated by those limitations in extant scholarship, a critical literature review was conducted to identify and critique relevant research to problematise the notion of personal recovery in the context of socio-structural disadvantage such as poverty, homelessness, discrimination and inequalities. The review illuminates the scarcity of empirical research and the paucity of sociologically-informed theorisation regarding how recovery is shaped by the socio-structural conditions of living. Those inadequacies are especially pertinent to homelessness research, whereby empirical investigations of personal recovery have remained few and undertheorised. The gaps in the research and theorising about the relational, contextual and socio-structural embeddedness of recovery are distilled. The critical review concludes that personal recovery has remained underresearched, underproblematised and undertheorised, especially in the context of homelessness and other forms of socio-structural disadvantage. Understanding how exclusionary social arrangements affect individuals' recovery, and the coping strategies that they deploy to negotiate those, is likely to inform anti-oppressive interventions that could eventually remove the structural constraints to human emancipation and flourishing.

Gênero, pobreza e saúde

As mulheres em situação de rua, parte de um fenômeno que se constitui como uma problemática global e inerente ao modo de produção capitalista (MPC), estão submetidas a uma série de opressões e desigualdades, especialmente alarmantes no que se refere a sua saúde. O objetivo do presente trabalho foi realizar uma revisão sistemática de literatura a fim de conhecer o que tem sido pesquisado sobre a saúde desse grupo de mulheres no contexto nacional e internacional, considerando-se as especificidades relacionadas à condição de gênero. Foram realizadas buscas nas bases de dados Lilacs, Redalyc, Psychinfo, SciELO, ERIC e no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brasil). A partir dos descritores homeless women, health, health care, health care policy e therapeutic itineraries, chegou-se a uma amostra final composta por 21 artigos, cuja análise foi expressa em três categorias: violência, pobreza e viver nas ruas: implicações para a saúde das mulheres; maternidade, trabalho e saúde: ambivalência sentida nos corpos; e acesso aos serviços de saúde e assistência social. Os achados evidenciam a interseção entre condição de gênero, situação de rua e saúde, apontando o caráter transcultural do fenômeno, e a necessidade de se investir em mais investigações na área.

Indigenous and non-Indigenous parents separated from their children and experiencing homelessness and mental illness in Canada

The purpose of this study is to examine the parent-child experiences of Indigenous and non-Indigenous mothers and fathers experiencing homelessness, mental illness, and separation from their children. A qualitative thematic analysis of baseline and 18-month follow-up narrative interviews was used to compare 12 mothers (n = 8 Indigenous and n = 4 nonindigenous) with 24 fathers (n = 13 Indigenous and n = 11 non-Indigenous). First, it was found that children are more central in the lives of mothers than fathers. Second, Indigenous parents' narratives were characterized by interpersonal and systemic violence, racism and trauma, and cultural disconnection, but also more cultural healing resources. Third, an intersectional analysis showed that children were peripheral in the lives of non-Indigenous fathers, and most central to the identities of Indigenous mothers. Gender identity, Indigenous, and intersectional theories are used to interpret the findings. Implications for future theory, research, and culturally relevant intervention are discussed.

Spaces of Exclusion: Safety, Stigma, and Surveillance of Mothers Experiencing Homelessness

Lack of affordable housing, poverty, and intimate partner violence are among the most common reasons for homelessness among mothers and their children in Canada. Mothers experience social exclusion in compounding and debilitating ways. In the literature on social exclusion and health, rarely is safety recognized as a prominent component of social exclusion. The purpose of this critical narrative study was to better understand the unique narratives of social exclusion for mothers experiencing homelessness in Ontario. A critical narrative methodology with an intersectional lens was used. Twenty-six ( N = 26) mothers participated in the study. The overarching finding of unsafe spaces represents the unique forms of exclusion from safety participants experienced in public and private spaces. Emerging out of this overarching category are two intertwined subcategories of (a) exclusion from safety and (b) stigma: public surveillance and discrimination. Participants’ narratives of exclusion from safety signify an ecosystem of unsafe spaces. The findings illuminate and reiterate the imperative for nurses to recognize that safety is a human right and is foundational for health. Nurses can use critical self-reflection and challenge the inherent “nursing gaze” to promote spaces of support rather than surveillance and engage in political advocacy to address structural inequalities, such as gender-based violence.

Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study

BACKGROUND.

Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being.

PURPOSE.

This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons.

METHOD.

A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation.

FINDINGS.

Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r _s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r _s = -.771, p < .01) were identified.

IMPLICATIONS.

Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.

Trauma-Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma-informed. While community mental health and other human services settings are moving toward trauma-informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle-driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second-order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.

Ontario’s Poverty Reduction Strategy

This article overviews the second phase of a two-phase study which examined experiences of health and social exclusion among mothers experiencing homelessness in Ontario, Canada. A critical discourse analysis was employed to analyze the policy document, Realizing Our Potential: Ontario’s Poverty Reduction Strategy, 2014–2019. In nursing, analysis of policy is an emerging form of scholarship, one that draws attention to the macro levels influencing health and health promotion, such as the social determinants of health, and the policies that impact them. The clear neo-liberal underpinnings, within the strategy, with a focus on productivity and labor market participation leave little room for an understanding of poverty reduction from a human rights perspective. Further, gender-neutrality rendered the poverty experienced by women, and mothers, invisible. Notably, there were a lack of deadlines, target dates, and thorough action and evaluation plans. Such absence troubles whether poverty reduction is truly a priority for the government, and society as a whole.

Social Exclusion and Health: The Development of Nursing Knowledge

The concept of social exclusion has been proposed as an important social determinant of health. However, use of the concept in health and health promotion research is in its infancy. In nursing discourse, in particular, exploration and application of the concept of social exclusion is minimal. The purpose of this article is to explore the relevance of the concept of social exclusion in the development of nursing knowledge. Current knowledge regarding social exclusion is examined and its use in health-related research is explored. To conclude, a conceptualization of social exclusion for the development of nursing knowledge is proposed.

Discrimination and well-being amongst the homeless: the role of multiple group membership

The homeless are a vulnerable population in many respects. Those experiencing homelessness not only experience personal and economic hardship they also frequently face discrimination and exclusion because of their housing status. Although past research has shown that identifying with multiple groups can buffer against the negative consequences of discrimination on well-being, it remains to be seen whether such strategies protect well-being of people who are homeless. We investigate this issue in a longitudinal study of 119 individuals who were homeless. The results showed that perceived group-based discrimination at T1 was associated with fewer group memberships, and lower subsequent well-being at T2. There was no relationship between personal discrimination at T1 on multiple group memberships at T2. The findings suggest that the experience of group-based discrimination may hinder connecting with groups in the broader social world — groups that could potentially protect the individual against the negative impact of homelessness and discrimination.

Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness

BACKGROUND

This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness.

METHODS

Data were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs. The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination, and what affects their capacity to do so.

RESULTS

Quantitative analysis revealed very high rates of perceived discrimination related to: homelessness/poverty (61.5%), race/ethnicity/skin colour (50.6%) and mental illness/substance use (43.7%). Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains. Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants: 1) social distancing; 2) old and new labels/identities; and, 3) 'homeland' cultures.

CONCLUSIONS

These study findings underscore poverty and homelessness as major sources of perceived discrimination, and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN42520374 . Registered 18 August 2009.

'My special time': Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal-infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face-to-face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, 'my special time' and three sub-themes, 'there is someone out there for me', 'it wasn't just a job' and 'swimming or stranded: feelings about leaving the service', were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self-determination in all therapeutic processes, including discharge, if recovery and self-efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.