# Personal recovery in mental health difficulties in people with experience of homelessness: qualitative systematic review

## TL;DR

This study explores how people who have experienced homelessness describe their mental health recovery and adapts a recovery model to better fit their unique needs.

## Contribution

The study expands the CHIME model into a new SECURED framework tailored to mental health recovery in homeless populations.

## Key findings

- Security and stability are essential prerequisites for other recovery processes.
- The SECURED framework includes processes like relationships, empowerment, and dual recovery.
- Housing alone is insufficient; other recovery processes must also be supported.

## Abstract

Given the complex challenges facing people experiencing homelessness, existing mental health recovery models are probably insufficient for this population.

To investigate qualitative accounts of mental health personal recovery in people with experience of homelessness, and to adapt the widely adopted connectedness, hope, identity, meaning and empowerment (CHIME) model of personal recovery to better represent the experiences of this population.

PROSPERO registration no. CRD42023366842. A systematic review identified qualitative studies investigating first-person accounts of mental health personal recovery in people with experience of homelessness. Nine databases were searched: CINAHL, SCOPUS, Embase, Medline, PsychINFO, PubMed, Web of Science, ASSIA and Social Services Abstracts. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Included studies underwent ‘best fit’ framework synthesis, comprising deductive analysis using the CHIME first- and second-order themes, as well as inductive analysis to capture aspects not covered by the a priori framework.

The review expanded the CHIME model and identified the following recovery processes in this population: security and stability; encouragement and hope; constructing identity; understanding and meaning; relationships and connectedness; and empowerment and dual recovery (SECURED). Importantly, security and stability were identified as a necessary prerequisite for the other recovery processes. Challenges within each recovery process were also identified.

SECURED offers a transdiagnostic framework to support understanding of mental health personal recovery in the context of homelessness. Findings support the Housing First model of service provision. However, findings also highlight that housing alone is not sufficient and that the other processes must also be supported.