Coping and resilience among ethnoracial individuals experiencing homelessness and mental illness

Abstract

Background:

The multiple challenges that ethnoracial homeless individuals experiencing mental illness face are well documented. However, little is known about how this homeless subpopulation copes with the compounding stressors of racial discrimination, homelessness and mental illness.

Aims:

This study is an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing homelessness and mental illness in Toronto, Canada.

Method:

Using qualitative methods, 36 in-depth semi-structured interviews were conducted to capture the perspectives of ethnoracial homeless participants with mental illness on coping and resilience. Transcripts were analyzed using thematic analysis.

Results:

Similar to prior findings in the general homeless population, study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing hope and optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to overcoming current challenges. In addition, participants described several coping strategies, including seeking support from family, friends and professionals; socializing with peers; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor.

Conclusion:

Findings suggest that homeless adults with mental illness from ethnoracial groups use similar coping strategies and sources of resilience with the general homeless population and highlight the need for existing services to foster hope, recognize and support individual coping strategies and sources of resilience of homeless individuals experiencing complex challenges.

Keywords

Coping resilience homeless ethnoracial minority groups mental illness

Background

People experiencing mental illness and addictions are over-represented among chronically homeless populations (North, Eyrich, Pollio, & Spitznagel, 2004) and face stigma and discrimination (Zerger et al., 2014), disruptions in employment and education, and social exclusion, along with stressors associated with unstable housing (Huey, Fthenos, & Hryniewicz, 2013; Williams & Stickley, 2011). Furthermore, among homeless people with mental illness, those from ethnoracial minority groups, compared to their White counterparts, additionally face racial discrimination (Zerger et al., 2014), language barriers, lack of knowledge about services, and services not tailored to their needs (Skosireva et al., 2014; Stergiopoulos et al., 2016). Homelessness among ethnoracial minority groups is thought to be increasing (Patterson, Markey, & Somers, 2012).

In Canada, immigrants from ethnoracial minority groups live predominantly in Ontario and 7 of 10 live in the three biggest census metropolitan areas, including Toronto, Canada’s largest urban center (Statistics Canada, 2010). About one-third of individuals experiencing homelessness in Toronto are immigrants to Canada, predominantly belonging to ethnoracial minority groups (Alliance, 2005). Although some studies have begun to describe the unique stressors and service access barriers facing homeless immigrants and refugees in Canada, including a study of newcomer homeless youth (CAMH & CAS, 2014; Hulchanski, Murdie, Dion, & McDonald, 2004; Murdie, 2005), little is known about how this population copes with the multiple compounding stressors of racial discrimination, homelessness and mental illness.

Coping refers to the constantly changing cognitive and behavioral efforts to manage specific external/internal stressors that tax a person’s resources (Folkman & Lazarus, 1985). A related concept, resilience, is generally understood as an individual’s capacity to overcome and recover from adversity through positive modes of adaptation (Huey et al., 2013). Investigators highlight various forms of coping, for example, emotion-focused versus problem-focused coping (Folkman & Lazarus, 1980), approach versus avoidance (Roth & Cohen, 1986), engagement versus disengagement, and productive and nonproductive coping (Cunningham, 2002). Problem-focused coping has been associated with positive mental health outcomes and resilience among homeless youth and adults in previous studies (Cleverley & Kidd, 2011; Kidd & Shahar, 2008; Littrell & Beck, 2001; Unger et al., 1998). Emotion-focused coping, on the other contrary, has been linked with poor mental health outcomes (Littrell & Beck, 2001), and other studies suggest that trauma and stress associated with homelessness may contribute to avoidant coping and poor resilience (Rayburn et al., 2005).

The literature on coping and resilience among homeless populations has focused primarily on women and families (Banyard, 1995; Banyard & Graham-Bermann, 1998; Huey et al., 2013; Rayburn et al., 2005), or youth (Bender, Thompson, McManus, Lantry, & Flynn, 2007; Cleverley & Kidd, 2011; Kidd & Carroll, 2007; Kidd & Shahar, 2008). The few studies exploring coping and resilience among homeless adults suggest that this population draws from a variety of coping strategies and personal attributes, such as direct actions, social support, patience and endurance, positive thinking, distancing, optimism, prayer and focusing on children or the future (Banyard, 1995; Holtrop, McNeil, & McWey, 2015; Huey et al., 2013).

Few studies have explored the relationship between ethnicity and coping, and these are predominantly about how African Americans and Latinos in the United States cope with stress from racism and discrimination (Brantley, O’Hea, Jones, & Mehan, 2002; Brown, Phillips, Abdullah, Vinson, & Robertson, 2011; Heppner, Heppner, Lee, Park, & Wang, 2006) or how these subgroups cope with the experience of homelessness – living on the streets, in shelters or treatment settings. Past studies have also described how mental illness and stress associated with being homeless both contribute to avoidant and ‘less adaptive’ coping strategies such as escapism, and in turn how these coping strategies contribute to increased emotional stress and depression (Banyard & Graham-Bermann, 1998; Dashora, Erdem, & Slesnick, 2011). Although researchers have commented on the complexity of these relationships, the literature on how people cope with multiple stressors, such as being a new immigrant experiencing homelessness and mental illness, is scant.

It has been argued that the assumption of a ‘general template’ for stress and coping lacks value ‘because the particular experiences and their meaning are colored and modeled by the different contexts in which they occur’ (Banyard, 1995, p. 888). Some researchers (Kuo, 2011; Ungar, 2008) have further argued that coping and resilience are shaped by ethnoracial and ethnocultural backgrounds and experiences, and that in the face of adversity individuals draw from a variety of internal (e.g. self-esteem) and external (e.g. family, community) resources, which bolster health and feelings of well-being in culturally meaningful ways (Ungar, 2008). Given that few studies have examined coping and resilience among ethnically diverse homeless populations with mental illness, this study undertook an in-depth investigation of the personal perceived strengths, attitudes and coping behaviors of homeless adults of diverse ethnoracial backgrounds experiencing mental illness in Canada’s largest urban center. Understanding coping and resilience in this population can expose their strengths and inform tailored interventions to support coping, health and housing stability.

Methods

Qualitative methods are best-suited to address our research aim, because they allow for a rich and in-depth understanding of the coping process (Banyard, 1995). This study was conducted in Toronto, one of five sites of a 4-year national research demonstration project – ‘The At Home/Chez Soi Study’(AH/CS) – designed to identify the service and system interventions that most effectively improve housing stability, health and quality of life for those experiencing both homelessness and mental illness. AH/CS, funded by the Mental Health Commission of Canada, has been described in detail elsewhere (Goering et al., 2011; Stergiopoulos et al., 2012).

Each AH/CS study site was tasked with examining the needs of a specific homeless subpopulation through a local ‘third study arm’ (e.g. aboriginal participants in Winnipeg, ethnoracial participants in Toronto, substance using participants in Vancouver). Foreign-born individuals account for nearly half of the population of Toronto (Statistics Canada, 2011). According to the 2011 Census, the racial composition of Toronto included White (50.2%), East Indian (12.7%), South Asian (12.3%), Black (8.5%), Southeast Asian (7.0%), Latin American (2.8%), West Asian (2.0%), Middle Eastern (1.1%), two or more races (1.5%) and Aboriginal (0.7%) individuals (Statistics Canada, 2011). The diverse makeup of the city is similarly reflected in its homeless population (Hwang, Stergiopoulos, O’Campo, & Gozdzik, 2012). The City of Toronto has identified ethnoracial and immigrant groups as being at high risk of homelessness (Stergiopoulos et al., 2015).

As per the study protocol, all AH/CS study participants experienced a mental disorder, with or without a co-occurring alcohol or substance use disorder. Study participants at the Toronto site were stratified, based on their level of need for mental health services, and randomized to either Housing First (HF) or Treatment as Usual (TAU) (Hwang et al., 2012). Ethnoracial participants with moderate needs for support randomized to the intervention were assigned to either a regular Housing First Intensive Case Management (HF ICM) intervention or a Housing First ethnoracial Intensive Case Management (HF ENR ICM) intervention.

Study sample

AH/CS Toronto site recruited a total of 575 study participants from health and social services that cater to the needs of homeless people in the city, of whom 338 self-identified as belonging to an ethnoracial minority group. Among them, 36 participants were recruited to participate in this sub-study, using purposeful sampling and the following criteria: (a) identified as ethnoracial minorities; (b) rated as ‘moderate need’ for mental health services, based on an algorithm described previously (Goering et al., 2011); and (c) willing and able to reflect on their experiences.

Data collection

A total of 36 in-depth semi-structured interviews were conducted between November 2010 and July 2011 by trained research staff to capture perspectives on coping and resilience of ethnoracial homeless participants with mental illness. The main interviewer identified as an ethnoracial person, possibly allowing for greater comfort and understanding of the experiences that participants described. All participants were fluent in English; thus, although there was access to interpreters, all interviews were conducted in English. Participants received monetary compensation of CAN$25 and transportation tokens for their participation.

Interviews lasted between 34 and 90 minutes, were audio-taped and transcribed verbatim. The terms coping and resilience were not explicitly used or defined in the interviews, aiming to elicit participants’ understanding of managing and overcoming stresses associated with their health and social challenges. The interview guide thus focused on exploring ‘life stories’ of participants around homelessness, race and mental illness by asking open-ended questions such as ‘How do you handle the difficulties?’, ‘What kept you going through these challenges?’, ‘What are your hopes for the future?’, as well as questions exploring participants’ coping with the intersectionalities of homelessness, race, mental illness, such as ‘What was it like to be homeless and having a mental illness in relation to your race?’(supplemental material). The study was approved by the Research Ethics Board at St. Michael’s Hospital, Toronto. Written consent was obtained from all participants.

Analysis

Thematic analysis (Braun & Clarke, 2006) was used to analyze our data. Beginning with a broad coding schema based on the interview protocol domains (e.g. experiences, coping and resilience associated with race, homelessness and mental illness), two analysts conducted line-by-line open coding of three transcripts and compared findings to resolve discrepancies and identify additional emerging codes. Once consensus was achieved, the primary analyst coded the remaining transcripts line-by-line. Throughout the coding process, the analyst met regularly with the principal investigator to discuss emerging themes and group codes into higher levels of conceptual categories (Braun & Clarke, 2006). NVivo 10.0 software facilitated data analysis.

Results

Sample characteristics

Table 1 summarizes participant demographic and clinical characteristics. More than three-quarters of participants (77.8%) were male. Their mean age was 37.1 (standard deviation (SD) = 11.3) years. Eight (22.2%) identified as Black African and Black Canadian, respectively, and six (16.7%) as Black Caribbean and of mixed ethnicity. Among the remainder, four (11%) identified themselves as Middle Eastern, three (8.3%) as South-Asian and one (2.8%) as Latin American. Two-thirds of participants (66.7%) were born outside of Canada and identified 19 different birth countries. The lifetime duration of homelessness was three or more years for the majority of participants (55.6%). One-third of the participants were Canadian citizens (33.3%), while less than half (41.6%) were landed immigrants. Around 11% of the participants had refugee status, while 5.5% were visitors to Canada.

Table 1.

Demographic and clinical characteristics of study participants (n = 36).

	n	%
Participant demographic characteristics
Gender
Male	28	77.8
Female	8	22.2
Country of birth
Foreign-born	24	66.7
Canadian-born	12	33.3
Ethnic or cultural identity (self-identified)
Black (Africa)	8	22.2
Black (Canada)	8	22.2
Black (Caribbean Region)	6	16.7
Mixed background	6	16.7
Other^a	8	22.2
Age (average ± SD)	37.1 ± 11.3 years
Residency status in Canada
Landed immigrant	15	41.6
Refugee claimant	4	11.1
Student	1	2.7
Visitor with intent to apply	2	5.5
Citizen	12	33.3
Other	1	2.7
Don’t know	1	2.7
Homelessness history
Lifetime duration <3 years	20	55.6
Lifetime duration ≥3 years	16	44.4
Clinical characteristics ^b
Current depressive episode	15	41.7
Current psychotic disorder	13	36.1
Current PTSD	10	27.8
Current substance abuse or dependence	13	36.1
Current alcohol abuse or dependence	10	27.8
Current alcohol or substance abuse or dependence	15	41.6

PTSD: post-traumatic stress disorder.

Values less than 5 are censored. As a result, the ‘Other’ category is made up of participants of Middle Eastern, South Asian and Latin American ethnic or cultural identity.

Based on MINI 6.0 InternationalNeuropsychiatric Interview.

Results from the mental health screening instrument, MINI International Neuropsychiatric Interview 6.0 (MINI 6.0)(Sheehan et al., 1998), revealed 15 (41.7%) met criteria for current depressive episode, 13 (36.1%) for a current psychotic disorder, 10 (27.8%) for current post-traumatic stress disorder (PTSD), 13 (36.1%) for current substance use disorder, 10 (27.8%) for current alcohol use disorder and 15 (41.6%) for either alcohol or substance use disorder. This subsample is comparable to the larger group of AH/CS Toronto site participants with moderate needs and to other chronically homeless populations in terms of gender, duration of homelessness and mental disorders. By design, 100% of our subsample self-identified as ethnoracial minorities and were more likely to be born outside of Canada (two-thirds compared with about half of the Toronto site AH/CS sample). In terms of AH/CS study arms, 12 (33.3%) received the HF intervention, 13 (36.1%) received an ethnoracial adaptation of HF and 11 (30.6%) received usual care.

Qualitative findings

Our study participants, not unexpectedly, described experiences of profound alienation, powerlessness, discrimination and cultural disconnect. They commonly referred to hardships of unemployment, poverty, interpersonal violence, immigration challenges or incarceration as overwhelming. Phrases like ‘I was devastated’ (Participant 30316, Black-African male) and ‘It’s terrible’ (Participant 30393, female) were common; however, nearly all participants described efforts to address and overcome their challenges. Relating to ways study participants responded to challenging experiences, two major themes emerged: (a) personal strengths and attitudes and (b) coping behaviors. Each theme and its sub-themes are discussed and illustrated below with representative quotes.

Personal strengths and attitudes

Participants made frequent reference to their personal strengths and attitudes as instrumental to managing and overcoming challenges while living in shelters or on the streets. Perceived strengths and attitudes included hope and optimism, self-esteem and confidence, insight into difficulties and spirituality.

Hope and optimism

Despite multiple stressors, 10 participants described having a positive outlook on life. They also described how hope and optimism helped them endure and bounce back from difficulties. As one participant highlighted, ‘Life is not over. I still have hopes; I still have a future. I can make it’ (Participant 30010, mixed racial background male). To help maintain optimism, participants talked about having ‘tolerance’ (Participant 30564, Black-African female), ‘patience’ (Participant 30010, Black/Indian male), ‘goal[s]’ (Participant 30296, male) and ‘future direction’ (Participant 30129, male). As to their hopes and aspirations, some participants linked them to mental health recovery – hopes to regain better health and overcome their social challenges. When asked about his hopes for the future, one participant stated, ‘I hope I get better, and I hope that I get out of my situation permanently. And I hope that … somebody thinks I deserve to live my life’ (Participant 30377, Black-Caribbean female).

Self-esteem and confidence

In the context of multiple overwhelming challenges, 10 participants described perseverance and confidence in their ability to succeed, citing personal stories of surviving on the streets, finding housing and engaging in training or employment opportunities. As one participant reported, ‘I just have a lot of self-confidence. If I really want something, I know I’m going to get it. Cause … I work hard to make sure that I get it’ (Participant 30234, Black-Canadian male). In addition to helping secure housing and training opportunities, participants described that self-esteem and confidence made it easier to endure experiences of racial discrimination as they arose. Like this participant described, ‘A healthy self-esteem is good, when I’m facing racism, it always feels so much easier’ (Participant 30308, mixed racial background male)

Insight into difficulties

Participants described that awareness and acceptance of personal and social challenges, particularly the impact of mental illness and homelessness, strengthened the coping process and supported help-seeking and goal-setting. More than half of the participants reported that mental illness and homelessness were perceived differently in their culture. For 27 participants, these experiences were alien: ‘There is nothing like homelessness in our culture’ (Participant 30010, mixed racial background male) and ‘They don’t understand what mental illness is’ (Participant 30393, female). Others associated mental illness with drug addiction, ‘evil spirit’ (Participant 30278; male) or being ‘bewitched’ (Participant 30382, Black-African male).

Due to these differences in perspective and experiences, insight into the impact of homelessness and mental illness or pathways to wellness and housing stability was sometimes partial, but crucial in the coping process. When these participants began to view their situation as a ‘real problem’, they were better able to engage in health care, housing searches, and strengthen skills of daily living (like cooking, budgeting) to maintain housing stability or employment. As this participant, working closely with a case manager to meet her goals, reported, ‘I just keep trying to get a job, like I’m going to try to keep my apartment that I have now. But it’s hard, because I have a mental illness’ (Participant 30393, female).

Spirituality

A total of 15 participants described drawing strength from ‘having faith’ in a higher power and were ‘thankful’ to this higher power for ‘taking care’ of them. For some participants, in the context of profound lack of trust toward others, religious faith was a source of comfort and support during times of struggle. ‘I pray to God and hopefully things will get straightened out, I have faith and trust and hopefully he’ll make all clear, because I had no faith in humans anyway’ (Participant 30227, Black-Caribbean male). Spirituality helped buffer both stressors related to housing and health challenges and experiences of discrimination. As one participant noted, ‘When it comes to, like, discrimination that does bother me, but I still carry my faith with me … we are all just one, created by Lord … be different colors, but we’re all human’ (Participant 30250, Black-Caribbean female).

Coping behaviors

When asked about handling stressors related to homelessness, mental illness and ethnoracial status,participants described a variety of coping strategies, including seeking instrumental support, socializing, engaging in meaningful activities, distancing or escaping from their challenges and finding ‘an anchor’. They described utilizing multiple coping behaviors at any one time, as for example, a participant who noted that while she used drugs and alcohol to ‘forget’ her problems, she also sought support from service agencies to address her housing crisis (Participant 30517, female). Participants also described that as situations/stressors changed, so did the focus of their coping behaviors. Describing attainment of housing, one participant stated, ‘It was such a great feeling … I now need to fight my mental illness’ (Participant 30393, female). As another refugee participant described a day-to-day approach when asked how he managed, ‘Today its immigration, tomorrow it is accommodation, the other day it’s a job’ (Participant 30360, male)

Seeking instrumental support

Almost all participants sought housing, income or health support from either one or multiple sources, including family members, friends, professionals (e.g. physicians, case managers, housing workers) and community agencies (e.g. drop in centers, shelters, churches). As one participant described, ‘I will go to my mom’s anyway on the weekends to shower, eat and … just sit in the house where I could lay my head’ (Participant 30227, Black Caribbean male). For some immigrant participants, their own community members were often sources of instrumental support related, for example, to immigration matters.

Although access to family support was limited for many, all participants described seeking professionals’ help to address their health and housing needs. Most participants appreciated such help, using words like ‘She [case manager] worked so hard to get me a nice place to live’ (Participant 30308, mixed racial background male) and ‘They [psychiatrist, social worker] provided all the help you need’ (Participant 30296, male). However, one-third of participants experienced discrimination and systemic challenges in the help-seeking process, as this participant, ‘I was trying to get on welfare and I felt she [case manager] judged me right away. The way I looked … she didn’t even give me a chance … She basically told me off’ (Participant 30393, female).

Socializing

In addition to seeking family and professional supports, participants expressed a desire to socialize and to build trust and a community of their own: ‘If I didn’t have people around I’d feel terrible … I’d feel much worse’ (Participant 30534, Black-Canadian male). They described the need to socialize for companionship, as well as to validate feelings and experiences around homelessness, mental illness or cultural disconnection. Like one participant described,

After I’d spoke with somebody that said you’re okay, don’t worry about it … it kind of helps you out a little bit just to have in the back of your mind … that somebody else out there, is listening and really cares. (Participant 30091, Black-Canadian male)

Participants also expressed the need to stay connected to their own ethnic community for support, as one participant described, ‘You have to plug into your [ethnic] community and [as] long as you have community … don’t burn the ties off to your community’ (Participant 30482, Black-Canadian male).

Meaningful activities

Almost all participants expressed the strong desire to engage in meaningful activities. As one participant stated, ‘You have to keep busy, cause if you don’t stay busy, then you’ll get problems … because you’re going to go back into the drugs’ (Participant 30482, Black-Canadian male). Participants described engaging in a wide range of activities including physical activities (walking, pursuing a sport) or creative (writing, computer classes, music) pursuits. Some participants were working part- or full-time, and others were pursuing education or training goals. Like this participant said, ‘I’m working part-time, and when I work, that time flies … I’m busy with something … that is really refreshing for me’ (Participant 30129, male). Other immigrant participants kept busy learning a new language or life skills. A participant recalled, ‘I was improving my English talking first of all … And it was getting much easier to ask for help when needed’ (Participant 30336, Black-African female). Engagement in meaningful activities often served as a pathway to improve confidence, regulate difficult emotions and adjust to a different culture, as well as deal with other stressors or as a means of distraction from challenges. As one woman said, ‘I have to write when I’m upset’ (Participant 30517, female), as a means of processing emotions and managing stress levels.

Keeping a distance

Seven participants described distancing themselves from stressful situations, like this participant: ‘I stopped talking to my sister long ago … it’s just a worry …. It’s like carrying my bag around all day. Without the bag, I’m free …’ (Participant 30534, Black-Canadian male). Similarly, another participant isolated from social circles to ‘hide’ his experience of mental illness: ‘Sometimes I have dry mouth … I’m shaking, or stuttering, so when I found myself like that, I tried to be isolated, so no one can know that I’m sick’ (Participant 30278, male). Likewise, avoiding confrontation or conflict situations, especially with police officers and other shelter residents, seemed helpful for some: ‘And some of them … because of my race, they will keep bugging. So I avoid confrontation. I used to keep away from them’ (Participant 30066, Black-Caribbean male).

Searching for distance or escape, some participants described turning to alcohol or drugs. As one participant noted, ‘I medicated myself seven days a week 24 hour a day … when I do drugs I’m like that little mouse in the corner … it’s very easy for me to ignore …’ (Participant 30227, Black-Caribbean male). Although some contemplated ending their lives, very few acknowledged attempts to do so. One participant reported engaging in self-harm behavior along with alcohol addiction; she noted, ‘I didn’t know how else to deal with the pain. If I didn’t have drugs or alcohol, I’d cut myself’ (Participant 30517, female).

Finding an anchor

Few participants (four) responded to feelings of powerlessness by identifying someone to serve as an anchor, a source of strength and support. Some considered their children as their ‘anchor’; even when these children were physically inaccessible, they were able to inspire hope in their afflicted parent. As this man described, ‘If I didn’t have children, I would have probably killed myself long time ago’ (Participant 30511, mixed race (Afro-Indian) male). They poignantly described their need to rebuild or regain lost trust or respect from children or family members, even if there was no longer hope of a relationship; for example, a woman described,

I think the most that helped me was having my son. I lost him to adoption. And it hurts every day. But now everything I’m doing, I’m doing it for him. So every time I think about overdosing on drugs or cutting myself, I don’t do it only because of him. I know who I have to live for. (Participant 30517, female)

Discussion

Our study suggests that homeless adults with mental illness from diverse ethnoracial groups navigate complex health and social challenges by drawing, like other homeless populations, from a diversity of personal strengths and coping behaviors. As coping and resilience are shaped by individuals and their cultures and contexts (Ungar, 2008), we anticipated that our findings might expose unique, culturally meaningful ways of coping and resilience in this subpopulation, such as connections with communities of origin and their traditions, and ethnic pride. Surprisingly, those did not emerge strongly in our data. It is possible that extreme poverty, disaffiliation and the long duration of homelessness experienced by study participants led to their identification with a ‘street culture’ and norms, overshadowing their own cultural backgrounds and early experiences.

Study participants recognized personal strengths and attitudes as great sources of coping and resilience, describing optimism, self-esteem and confidence, insight into their challenges and spirituality as instrumental to survival. Previous research on homeless youth and adults has revealed similar findings (Huey et al., 2013; Kidd & Carroll, 2007; Thompson et al., 2016). Hope and optimism have been associated with self-esteem, goal-setting and overall recovery in other studies (Kirst, Zerger, Wise Harris, Plenert, & Stergiopoulos, 2014; Leamy, Bird, Boutillier, Williams, & Slade, 2011), of homeless people and people experiencing mental illness. Similarly, spirituality emerged as an important contributor to resilience, consistent with previous research linking spirituality to overall well-being in both homeless youth and adult populations (Banyard, 1995; Thompson et al., 2016).

Participants further described self-esteem and confidence as important fuels to remaining hopeful and resilient. Despite experiences of racial discrimination, many participants maintained a positive perception of themselves as ‘resilient’ and confident. The importance of self-esteem and confidence contributing to resilience has been previously identified among younger homeless youth (Kidd & Shahar, 2008).

In addition to drawing from personal strengths and attitudes, participants described using several coping strategies, including seeking support from family, friends and professionals; socializing; engaging in meaningful activities; distancing from overwhelming challenges; and finding an anchor. These findings both support and are supported by previous research withhomeless youth and adults (Banyard, 1995; Bender et al., 2007). Prior studies have identified that the ability to create and maintain supportive relationships with peers and professionals serve as an important protective factor in the face of hardship among both homeless youth and adults (Bender et al., 2007; Huey et al., 2013; Littrell & Beck, 2001; Thompson et al., 2016). Not surprisingly, our participants sought family, professional and peer support to address emotional and practical support needs and achieve social connectedness.

Furthermore, similar to previous work (Huey et al., 2013), participants described engaging in physical or creative activities to cope with past and ongoing stressors. In keeping with other studies, our participants also described turning to drugs, or engaging in self-harming behaviors as a way of coping (Williams & Stickley, 2011). This is similar to the concept of hidden resilience (Ungar, 2006) seen among homeless youth, wherein nontraditional coping behaviors such as addiction may be used as a way of escaping from problems. Finally, finding an anchor and trying to be a role model for loved ones served as a grounding experience, even in the phase of permanently damaged relationships and little hope of reconciliation. Research on homeless youth and adults living with their children has similarly identified this focus on children and loved ones as a source of resilience (Banyard, 1995; Holtrop et al., 2015).

Of note, similar to previous work (Henwood, Derejko, Couture, & Padgett, 2015), our findings suggest that in the context of pressing survival needs, homeless study participants relied on multiple coping strategies, including efforts to achieve self-actualization. This process of coping and resilience is different from Maslow’s theory of motivation, prioritizing basic needs over higher order goals (Maslow, 1943), and suggests that homeless service providers may need to support service users at multiple levels, rather than focusing on most pressing basic needs.

Limitations

Findings emerge from a convenience sample of ethnoracial homeless adults with mental illness, able and willing to offer a rich description of the perspective and experiences. The larger AH/CS study, from which these participants were drawn, recruited a representative group of adults experiencing homelessness and mental illness in Toronto, Canada. As study participants were recruited from a single urban center, their experiences may differ from those of ethnoracial groups experiencing homelessness and mental illness in other jurisdictions. Nonetheless, our findings resonate with previous research with homeless populations in other settings. Finally, the study explored resilience and coping behaviors of homeless adults, but not the effectiveness of those coping strategies.

Conclusion

Our findings expose many strengths and sources of resilience among ethnoracial homeless adults with mental illness, similar to other homeless populations, and highlight the need for greater attention to supporting and strengthening coping and resilience of affected individuals within existing service delivery systems. Future research with homeless populations should strive to understand the relationship between acculturation and coping, and how coping strategies may change over time in the context of chronic stressors (Gamst et al., 2006).

Footnotes

Acknowledgements

We thank Jayne Barker (2008–2011), PhD; Cameron Keller (2011–2012); Catharine Hume (2012–present) Mental Health Commission of Canada At Home/Chez Soi National Project Leads, Paula Goering, PhD. The National Research Lead, the National Research Team, the five site research teams, the Site Coordinators, and the numerous service and housing providers, as well as persons with lived experience, who have contributed to this project and the research. We also thank Suzanne Zerger for her substantial contributions to the analysis and manuscript preparation.

Author contribution

S.P. and S.C. contributed to data analysis and manuscript preparation; T.B. contributed to manuscript preparation; and V.S. conceived and designed the study, additionally coordinated the study, contributed to data collection, analysis and manuscript preparation. All authors read and approved the final manuscript.

Availability of data and materials

The datasets generated and/or analyzed during this study are not publicly available due to confidentiality reason but are available from the corresponding author on reasonable request.

Ethical approval and consent to participate

The study was approved by the Research Ethics Board at St. Michael’s Hospital, Toronto. Written consent was obtained from all participants.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Health Canada.

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