PROGRAM  Warsaw  draft



1.      Introduction- why this pillar (why this issue is important)


Providing accommodation to homeless people is essential for a new beginning but it should definitely not be the final goal of our interventions; if this is not joined with meaningful activities or a purpose in one’s life then it might lead to isolation and loneliness. Especially for homeless people with mental health problems and/or addictions, lack of socializing and being part of a community may also lead to institutionalization.

Thus, another approach, recovery, is necessary in order each person to be able to find his/her personal meaning of life. But what do we really mean by this term?

Some of the most common definitions are the following:

A deeply personal, unique process of changing one’s attitude, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful life, and contributing to life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness. Recovery from mental illness involves much more than recovery from the illness itself. (Anthony, 1993).

P.Deegan some years earlier (1988) reported for the first time recovery:

«As a journey rather than as a destination», pointing out that it is about the process and not necessarily the result. She described it as:

  “…the living or present experience of real life in people, as they accept the difficulty of their disability and they overcome it”.


Recovery from the userspoint of view is referred to a personalized process, which is connected with the growth of future hope, the discovery of a new meaning in life, empowerment, development of personal skills and strategies, a safe economic and social base, supportive relationships and social integration.                                                    

                                                                                                  (Repper&Perkins, 2006)


Of course these are not the only definitions. However, in all of them the central meaning is "to live a meaningful life in the community and strive to achieve your potentials". Thus, recovery is above all a basic human right. Everybody has the right to have a meaningful and fulfilling life, although for some recovery might have to be built from “scratch” rather than recovered.

Recovery needs also to be placed into practice in a collaborative way and to be co-constructed. As it is obvious, this is a different approach and "paradigm" and we have to keep in mind the United Nations' Convention on the Rights of People with Disabilities, which means a shift from medical to social model of disability.

 In practice, this means to focus on overall health and wellness, to face service users as individuals with roles rather than as patients, to help them strengthen their self-organization and self-representation and above all to focus on opportunities rather than on deficits and weaknesses.

In this perspective, Recovery should be transversal in all interventions as it is strongly connected with other basic rights:

·         right to housing

·         access to health services

·         access to basic goods

·         access to education and training based on individualized needs

·         the right to live independently in the community of your choice

·         the right to participate in the community life and being included as an equal member of the society

·         the right to work and have the support to find work


At this point it is worth mentioning that regarding housing, there is a dispute about the roles of Housing First and Shelters in recovery.

Some argue that Housing First supports recovery more than a shelter, as it is housing without conditions and this provides someone with time and space to recover. Through housing first, we alter the focus point from participation to citizenship in a broader way in society.  Instead, in a shelter there are a lot of people for a short period of time and for recovery, which is a slow process, this is not an ideal situation as it is not feasible so many people to be stimulated and motivated in order to recover themselves.


Others, still claim that a shelter can provide a great deal of meaningful participation, as in many shelters nowadays, service users are invoiced with participation in cleaning, catering, kitchen work etc.. From this perspective, the shelter is a first community where people have to contribute to stay in; that fact gives meaning, purpose and structure in their daily life.


2.      Main ideas we want to highlight


·         Is a process not a state; It is a process of change, through which individuals improve their wellness and life and lead themselves to autonomy. This means being a person instead of a patient. It also means that one can support himself/herself and not being dependent on other people.

·         Is a personal journey and everybody recovers in his own time. Thus, it should be supported by -but not managed by- a professional. The first reason for that is related to the most widely held view that a person's needs and a professional’s opinion for the purposes of the same individual can vary greatly (Lasalvia al., 2005; Thornicroft & Slade, 2002). In addition, the needs that have been assessed by the service users themselves are much better indicators for the assessment of quality of life compared with those reported by professionals (Slade, Leese, Cahill, Thornicroft, & Knipers, 2005). The second reason is related to the individual's right to make his/her own decisions, even if it is proved in the way that it was the wrong choice or that his/her decisions were harmful and risky. The right to take personal risks and regain the control of one’s own life, through free will, fits into the broader context of the concept of recovery and should be assigned, even if there is strong disagreement or concern for the results of this choice (Slade, 2009).

·         IS NOT TREATMENT. Recovery and Treatment are two different things. Recovery is about gaining self-management. According to this approach, a person takes risks, for example, he returns to work, but at the same time he has strong support from his family and the professionals (Chamberlin, 2005). The users themselves must manage the row recovery – it is RECOVERY BY THEMSELVES with support.


·         The key to recovery is to establish a trustful and meaningful relationship between the homeless and the professionals.  Through that relationship choices and options can be given to the persons regarding  their needs and will. Especially in the interventions with homeless people with mental health problems and/or addictions the outreach/proximity approach can provide rapid responses to their needs and give access and clear pathways.  Stabilisation of one’s situation is the first process, followed by finding one’s self again and starts to enjoy life.


·         The road to recovery is never straight and there’s no predetermined destination. The role of recovery is to install hope, to give positive perspective (of course not unrealistic); to support, connect and discover opportunities as well as to respect needs and choices focusing on strength, self-determination and somebody’s own resources, instead of focusing on symptoms and deficits. It is a holistic approach, facing users as individuals with roles rather than as patients.


·         For someone to gain or regain self-respect, self-confidence and meaning in life is to feel incorporated; to feel that he/she belongs in a community and he/she is somebody not only accepted but worthy as well. All the above can be gained partly through connection with others, being active citizen and having a job. However, regarding the issue of “job”, there is a dispute. On the one hand, job is considered to be very important in the process of recovery, as it can lead to self-support, independency and recognition. Besides that, earned money/salary can be also linked to dignity, as it is one kind of exchange. Moreover, through job homeless people can gain a structure in their life and a purpose. Thus, for some people job can definitely be a step towards recovery, especially if  we focus on real jobs, which means links to jobs or social cooperatives, reinvention of  jobs and readjustment of occupational training. On the other hand, it is important to be underlined that job may be important but it is not everything. In some cases, especially in the countries that lack social welfare and where there’s no access to social benefits, job is a vital solution. However, there are people who will not or ever be able to work (i.e. older people or more severely ill), so we have to recognise and accept diversity. If we consider job to be prerequisite for recovery, we may “trap” people into vicious cycles of training without any success. Therefore, it is important to have in mind that it doesn’t necessarily have to be a job in order somebody to gain a purpose in life or feel self-efficient. It can also be a hobby or other social and meaningful activities. Professionals’ “work” is to empower people to follow their own pathways.


3.      Difficulties we might expect


·         Recovery is considered also to be “a return to a normal state of strength, mind and means”.  However, the perception of normality is a statistical concept, but each one of us has a subjective approach to it and therefore this has to be taken into account when working with people that have been exposed to severe life events and have created a certain “personal way” to interact with the environment.

·         Lack of person-centered approach especially in big institutions (shelters, hostels etc.). This, combined also with the fact that being a service user sometimes becomes a “full-time job”, can lead to institutionalization.

·         The lack of social welfare in combination with lack of jobs in the free labor market that appears in more and more European countries, due to the socioeconomic crisis. Even in the countries that there are available jobs though, free labor market seeks for performing workers and that can be a barrier for people with mental illness and homelessness. (This is not observed in social cooperative style businesses, though).

·         There is also a controversy in the issue of labor, in the way that labor could be different from a “job”. Very often it could be seen as an inclusive action in the community and not as work, on its own right. As labor/ work is a strong symbolic identity feature, the idea of constructing somebody’s identity through labor has to be looked at very carefully. If that construction is achieved in a specially “developed job”, targeted for people with mental illness and homelessness, to what extent do we identify them with their illness and to what extent do they see themselves with that condition and not as citizens with rights and responsibilities?

·         The staff in institutions and services can get frustrated with the process of recovery if they are not well trained and supported. Stereotypes and misconceptions can lead to the constant marginalization and discrimination of homeless people, especially those with mental health problems and/or addictions. Thus, staff needs to be given the tools to clearly understand that treatment does not equal recovery. Teams have to be given time for reflection, team approach, mentality and culture of networking, communication within and out of the team.  This is essential in order them to understand that recovery process takes time and during this process we have to deal with frustrations, steps back and forward and at the same time respect people's own recourses.  A team has to be constantly supported to be flexible (see also next chapter about staff care-staff training).

Summarizing, we could say that some people may be stuck to vicious cycles because we offer them solutions that do not fit to their needs or to their present condition. So, we should first listen to the needs and then offer!


4.      Good practices to face those difficulties

          The person -centered approach seems to be the foundational approach style, as it is very important to meet people where they are and listen to each one’s hopes and dreams. In other words, it should be a co-work between the homeless people and the professionals. First we listen (without being judgmental or intrusive) and then we co-construct the individualized plan for and with each person according to his/her capability and will.

          Different work models are available which in general could be divided in a stepwise model and non-step wise model. Most professionals agree though that since a person-centered approach is used, a tailor-made plan is needed and not a step by step. Tailor-made plan means a plan according to a person’s choices, potentials and impairments.

·        Provision of appropriate levels of care according to the individual's needs, avoiding oversupply of care and treatment, which poses the risk of long-term dependency, gradual loss of autonomy and empowerment. At the same time, being alert for availability and flexibility in crises and relapses.

·        Networking is also of vital importance, specifically a person-centered networking, which means collaboration among the different services based on the special needs of each person every time. The complexity of the problems that homeless people are facing, demands progressive assistance and support from different professionals in social services, health services, etc. So, it is important to facilitate with formal and informal associations and community resources, something that requires high level of expertise among the professionals as well as flexibility and “thinking out of the box”.

·         Continuity of care: is the process by which the person and the professional are cooperatively involved in ongoing care management toward the shared goal of high quality, cost-effective care. It also facilitates the services by making early recognition of problems possible. Continuity of care is rooted in a long-term partnership in which the professional (or the team) knows the person’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation or record review. In that way, it reduces fragmentation of care and improves person’s safety and quality of care. Continuity of care is strongly connected with the ongoing follow up, whereas it presupposes the existence of a network.

·          Harm reduction: refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. It is a targeted approach that focuses on specific risks and harms and all the interventions are grounded in the needs of individuals. As such, harm reduction services are designed to meet people’s needs where they currently are in their lives. Harm reduction opposes the deliberate hurts and harms inflicted on people who use drugs in the name of drug control and drug prevention and promote responses to drug use that respect and protect fundamental human rights. In this case, such interventions, respect people have will and help them become gradually more and more responsible for their choices and their lives.

·         Low-threshold approach:  refers to programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling.

·         Mutual self-help groups, peer support specialists, peer-run programs: groups or programs runned by persons who have experienced homelessness and sometimes they have also faced addiction problems or mental illness. Through these groups or programs open dialogue, consultation and in some cases even debate is encouraged. Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. A peer is in a position to offer support by virtue of relevant experience: he or she has "been there, done that" and can relate to others who are now in a similar situation. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training).

·         Active citizenship: A wide range of stakeholders should be meaningfully involved in policy development and programme implementation, delivery and evaluation. In particular, people who have experienced (or still experiencing) homelessness should be involved in decisions that affect them and should be given the opportunity to be active in their communities and be able to use the community resources or other means that reinforce human bonds.


5.      Practical case to make a reflection exercise to use in a context of training

From our visits to the countries of the participants in this Erasmus+ project, we have seen a few examples considered to be good practices and that could be noted here:

In Lisbon:

o   “Solidarity Lockers”, through which people are integrated into the community whereas others even succeed in getting casual work. (Needs further elaboration).

o    Workshops where people do crafts? (needs further elaboration).


In Greece:


a)       Social cooperatives of Limited Liability (SCOLL)


The Social Cooperatives of Limited Liability (SCOLL - KoiSPE in Greek), which are Private Law Entities, with limited liability of their members,  were instituted by L. 2716/1999 "Development and Modernization of Mental Health Services and other provisions "(Government Gazette 96 A / 17.05.1999) of the Ministry of Health for the" Development and modernization of mental health services ". The SCOLL have  a commercial nature and can develop any economic activity supporting it by vocational training programs for their members, as well as sheltered laboratories, and Supported employment Pertaining to the Social Cooperative Enterprises, economic migrants, refugees and mentally ill individuals are among those groups that are being provided for by the Law 4430 of 2016. So, they are a special form of cooperatives, since they are both productive/commercial units and also Mental Health Units.

The activities of SCOLL aim:

·         To ensure the viability of the enterprise and the continuous creation of new employment positions;

·         To be active in the local open market

·          To maintain a balance between the entrepreneurial strategy and the social aims;

·         To fight and eliminate the social stigma, through – among others - the creation of a work identity and the improvement of the financial position of the Cooperative’s members;

·         To establish cooperation with the family and the therapeutic framework and provide counselling support to the members;

·         To provide continuous education and vocational training to its members with psychosocial problems;

·         To provide continuous education and vocational training to its staff and collaborators - mental health professionals, so as to contribute to the employment of people with special needs, disadvantaged and psychosocially challenged.


b)      Invisible Tours, the social tour

It is a social tours program based in the capital of Greece, Athens, in which homeless people become tour guides -and indeed, community leaders- in a very different kind of a city walk. This is a tour that does not take people to the archaeological treasures of the city but leads them through the backstreets of central Athens. As is the case with other social tours organized by street papers all over the world (Hamburg, Basel, London, Munich etc), the tour introduces visitors to some of the important social and solidarity institutions of the Greek capital (soup kitchens, day centers, drug rehabilitation centers, homeless shelters etc). The guides provide information on the types of services offered by each institution as well as how they themselves have experienced or are still experiencing homelessness. The goal of these social tours is to energize the person who is leading the tour and to create new ways for him/her to support himself/herself, providing new training and educational opportunities and supporting them to move a step closer to social (re)integration.

We have to be careful not to stick with the label of homeless and "sell"  this idea!

c)       Homeless football team- uses football to energize people to change their own lives and raise social awareness

d)      - “Job first” initiatives?




6.      Glossary - key words:


-          Co-construction: the delivery of public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbors.  (Boyle and Harris, 2009).

-          Connecting: joined or linked; linking two things

-          Empowerment: to take their lives into their own hands an opportunity to control their own life. There was much discussion on the use of the word empowerment. Empowerment is an external action, but it is also a two way relationship, it can drive someone to recovery but recovery can also lead someone to empowerment.

-          Establish relationships: create and maintain a connection of mutual trust, transparency and respect between a professional and a client (in our case a homeless person with mental difficulties). This is the basis for any further planning and cooperation. Confidentiality and honesty from the professional. A caring attitude but also set limits.

-          Institutionalization:

-          Network: a group or system of interconnected people, services or organzations. They interact with others to exchange information and develop professional or social contacts. It may be official (see the example of INPISA in Lisbon for homelessness) or unofficial.

-          Personal Choice: involves decision making. It can include judging the merits of multiple options and selecting one or more of them. One can make a choice between imagined options ("What would I do if...?") or between real options followed by the corresponding action. It is associated with free will. (through Wikipedia).

-          Recapacitation: To facilitate the capacity to recover.

-          Recovery: see the definitions given in the beginning of this chapter.

-          Step by step approach: The method in which does something carefully, gradually and in particular order (Longman Dictionary).













          American Academy of Family Physicians (1983) (2015 COD)

          Appleby, L. (2007). Breaking down barriers: The clinical case for change. London: Department of Health. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074579

          Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16, 11-23.

          Deegan, P.E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11(4), 11-19.

          Repper, J. & Perkins, R. (2006). Social inclusion and recovery: A model for mental health practice. Edinburgh: Bailliere Tindall.

          Recovery and Independent Living Professional Expert Group (R&IL PEG) (2010).   Recovery orientated prescribing and medicines management. Retrieved from http://www.recoverydevon.co.uk/download/prescribing_project_report_FINAL_PEG_Advisory_Paper_8.pdf.




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