Understanding program models to address homelessness and serious mental illness: A qualitative inquiry of service providers

Within the mental health system, there are two distinct service models for adults experiencing homelessness who have severe mental illnesses and co-occurring addictions: one prioritizes treatment before accessing permanent housing (Treatment First), while the other provides immediate access to permanent housing followed by clinical support (Housing First). This study makes use of qualitative methods to compare the views of 20 providers working in Housing First versus 21 providers working in Treatment First programs. Emergent thematic findings show that despite working with the same target population, Housing First providers more closely align with a recovery orientation than do Treatment First providers - a difference that is influenced by the organizational/program context itself. Such practice-based research affords an opportunity to learn valuable lessons about program and service implementation, which is a vital and often missing component within mental health policy decisions.