Mental illness is prevalent in the population served by Housing First programs. But, the stability of housing puts people in a better position to improve their mental health and avoid the most harmful consequences of having a mental illness like hospitalization or suicidality. Harm reduction is a critical ingredient of the Housing First Model and can be used to work with participants around all potentially risky behaviors, including managing the symptoms of a mental illness. Service providers can use a harm reduction approach to proactively engage with people about the symptoms they experience and the tools they have already developed to manage them.
As we discussed in our previous post, people with a mental illness may not want to use psychotropic medication or take it as prescribed. In addition, the benefits of medication are enhanced by other therapeutic supports. For these reasons, it’s important to seek strategies beyond medication that promote mental health. A case manager’s goals should include assisting participants with learning about their mental illness and the potential risks, developing a menu of ways to address their symptoms, selecting the strategies they believe are most realistic or effective, and evaluating how their plan is working out. Below, are a few simple considerations for building a toolkit of options for people with a mental illness. Please feel free to submit a comment with your other creative approaches and ideas!
Diet, Exercise, Sleep
Most people are aware of the impact that diet, exercise, and sleep have on our physical health. All of these can significantly impact our mental health as well. Starting off with an exploration of these basic needs is one way to address mental health. If someone doesn’t get enough sleep, the results are predictable—low energy, irritability, and a lack of focus to name a few. These effects are exacerbated by the presence of a mental illness. Although people are quick to jump to medication as a solution to sleep problems, there are other alternatives. Good sleep hygiene can include having a regular routine (e.g. regular bedtime before 11 pm or wearing specific clothes to sleep in), allowing time to wind-down, using relaxation techniques, and reducing exposure to light and noise from electronic devices.
Regular exercise also contributes to better mental health. Simple forms of exercise like walking, stretching, or calisthenics (push-ups, jumping jacks) can improve our sleep routine and reduce stress. I worked with one participant diagnosed with Bipolar Disorder who chose not to take medication. Instead, he rode his bike everywhere and by the end of the day was so exhausted that he didn’t struggle to get to sleep. Exercise generally promotes better mental health by releasing endorphins that reduce depression and improve memory, concentration, and other mental tasks. It is important to start slow and consider a person’s ability since many participants in Housing First programs have physical limitations.
There’s a reason case managers check the fridge on home visits and ensure that participants have adequate access to food resources. Our diet can also affect our sleep routine and overall mood. Eating sugary products or drinking caffeine too close to bedtime can make it hard to fall asleep or sleep soundly. Besides impacting sleep, diet alone can affect our mood. People report having a better mood when they regularly drink water and eat a variety of fruits and vegetables, as well as other foods high in fiber or magnesium. On the other hand, diets that are high in saturated fats and calories lead to depression. Diet, exercise, and sleep are connected and can improve mental health through awareness and proper attention to them.
A Network of Support
People need connection. In their article “Applying addiction harm reduction lessons to mental healthcare” Krausz et al. explain, “strong evidence shows that for a successful recovery, long-term support, stable relationships and the involvement of peers and family members is critical.” Case managers in Housing First programs are often the primary stable, supportive relationship in a participant’s life. This relationship is uniquely safe and consistent because case managers in Housing First programs will not abandon a person because they had a bad day or got evicted from their apartment. The work of building a supportive network begins with case managers and grows from there.
Case managers can help build a participant’s network of support by linking them to the professional help of therapists, psychiatrists, nutritionists, and other service providers. They can also help a participant find peer supports by making connections with other people who have lived experience with aspects of their own life. Some Housing First programs do this by offering outings like picnics or movie nights for participants to connect with other people in their own program. Case managers might also work with participants to help them reconnect with family members. Relationships promote recovery by fostering connection and making assistance available when people are struggling to cope with their mental illness.
Moving into supportive housing enables participants to get out of survival mode. With their basic needs met and social connections established, people can eventually pursue higher level needs like the desire for purpose. Some participants achieve this by going back to work. But, even those who are not capable of returning to employment can be encouraged to find other meaningful and satisfying pursuits. Participants may pursue volunteer opportunities in shelters, food pantries, or other service organizations that they previously went to for help. Other Housing First participants have decided to volunteer at local farmers markets, community organizing groups, or animal protection agencies. Pursuing an interest or hobby such as writing or art making can bridge the need for a social network and meaningful activities. Many resourceful case managers have helped participants explore their interests and connect to broader social networks by providing access to computers and the internet. Resources like Meetup allow participants to search for people with similar interests and join local groups that aren’t necessarily focused on a shared experience of mental illness.
Logotherapy is one approach to improving mental health that emphasizes finding purpose and meaning in people’s lives. As Victor Frankl explains in Man’s Search for Meaning: An Introduction to Logotherapy, “What [a hu]man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task.” This idea parallels the harm reduction approach. Instead of focusing on the absence of all symptoms or problems, self-worth is achieved through a commitment to a process of positive change. As with all aspects of harm reduction, it is important to explore options with participants and help them choose the ones that are most meaningful and accessible to them.