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Book Reviews   |    
Homelessness, Housing, and Mental Illness

Homelessness, Housing, and Mental Illness
by Russell K. Schutt. with Stephen M. Goldfinger.; Boston, Harvard University Press, 2011, 402 pages, $49.95

Reviewed by Mark Ragins, M.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.20120p192
View Author and Article Information

The reviewer reports no competing interests.

Dr. Ragins is medical director, Mental Health America of Los Angeles-Village, Los Angeles, California.

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This book revisits one of the seminal and influential homelessness studies of the early 1990s, the Boston McKinney project, a joint endeavor with the National Institute of Mental Health. Using a variety of measures, it compares people randomly sent from Boston's mental health shelters to either empowerment-oriented small-group housing or to supported scattered-site housing. The data from this project have already informed, according to the author, “two dozen articles and book chapters.”

I am middle-aged, and I can understand the appeal of summarizing important life work into a comprehensive book. However, don't expect rocking-chair reminiscences or stories of glory days here. Also don't expect long-term follow-up data or clinical discussions. This book is written primarily by the research sociologist for the project. At its heart this is a scholarly, field-based sociology book built upon literature reviews, ethnographic notes collected by the author, and correlational data analysis. It reads like a very long journal article, which, frankly, is not my favorite writing style.

The book is organized around chapters covering social relations, substance abuse, mental illness, community functioning, and housing loss. Throughout, it incorporates discussions of several crucial theoretical issues and models, including whether a person's traits or environment is more influential in determining behavior when the person is housed, the process of engaging in small intentional homogeneous communities versus engaging in the larger social community, the impact of accepting versus rejecting support, and client needs versus wants. Each discussion remains bounded by the research findings and eschews stimulating speculation (for example, as to why black clients were stunningly unlikely to maintain independent living but did as well as whites in the group settings). It also refrains from making overt clinical or policy recommendations.

The most controversial chapter is likely the one that discusses how staff assessments of client needs are more predictive of client success in each type of housing than of client desires—anathema to much of today's recovery movement. I thought the most compelling chapter was the one on empowerment that uses house meeting notes to describe the heartbreaking process of staff becoming increasingly frustrated and disillusioned with their inability to make empowerment work in the small-group housing.

As a mental health staff member, I would have liked more about staff issues and services overall, but they were neither the object of the study nor seemingly even especially interesting to the author. This disinterest may make the book of substantially less relevance for readers who are staff members looking for insights into their work fighting homelessness.

I also felt as though I was in a time capsule while reading this book. Although the sociology references are up to date, the services mentioned felt outmoded to me. I believe that recovery-oriented staff and services can make a profound difference in people's lives, so I was left wondering whether the research findings apply to today's programs, especially the best ones. Maybe we've made progress helping homeless people in the past 20 years—a possibility that this book doesn't really address.

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