In the last decade, a wave of initiatives and actions has involved consumers in research, policy, planning, and service delivery; given increased prominence to choice-based approaches to housing and services; and created a growing body of supporting research evidence. The current momentum of consumer-driven programs and expansion of consumer roles emerged in the context of broad social changes limiting the use of public resources to address poverty and homelessness. Activism driving consumer involvement arose from the consumer/survivor movement in mental health services and has carried over into homeless services and advocacy. Concerns about HIV/AIDS, managed care, and a shrinking safety net have also been energizing forces. Even under unlikely social conditions, consumers and their allies have found ways to advance a more consumer-centered agenda in homelessness policy and services.
The context for these developments is complex. Several broad social trends have converged in the last decade to force a reassessment of approaches to homelessness:
- Reduced public commitment to social spending has coincided with losses of affordable housing, growth of wealth and health disparities, escalating incarceration of minority and disabled individuals, and a failure to stem the growth of homelessness.
- Penetration of market principles and management technology into health care and public services has produced managed behavioral health care (Mechanic, 1999) as well as new attention by public agencies and providers to cost saving, outcomes-based management, and evidence-based practice (Nelson et al., 1995); at the same time, demands for personal responsibility on the part of vulnerable groups have increased (Bishop & Brodkey, 2006).
- Even as these processes reflect and promote reductions in social welfare spending, consumers have turned them into new openings for activism:
- Consumers have adopted and reframed calls for personal responsibility to emphasize individual choice, encouraging people to act as agents on their own behalf (National Mental Health Consumers Self-Help Clearing House, n.d.).
- The recovery paradigm in mental health, promoted by the consumer/survivor movement and its allies, is challenging old assumptions about capabilities of consumers and making recovery, self-determination, and choice defining principles (Anthony, 2000; Campbell, 2006a; Mueser et al., 2002).
- Recovery has entered the federal mental health agenda (New Freedom Commission, 2003; SAMHSA, 2005c; US Department of Veterans Affairs, 2005).
- Consumer-operated programs and choice-based program models (Campbell, 2006b; Teague et al., 2006; Tsemberis et al., 2003) are being developed, tested, and disseminated.
- Ten-year plans to end homelessness are expanding opportunities for consumer-focused and choice-based approaches.