Development and Process Evaluation of an Activity- and Recovery-oriented Intervention for People With Severe Mental Illness Living in Supported Housing - Active in My Home (AiMH)

Background and Main Purpose People with severe mental illness (SMI) say that being active and taking part in social interaction are the most essential elements for being able to experience meaning in life. Interventions and research into activity for this target group have so far been concentrated on work rehabilitation and on meaningful activities in community-based activity centres. The common denominator here is the assumption that the individual leaves their residence in order to engage in activities. The focus of this application is, however, on the individual's situation in their home environment. The latter can vary from living in one's own apartment/ house without support, often termed ordinary housing, to supported housing (SH), which links housing and support and is situated in supervised group homes or apartments located in one building. An intermediate form is housing support, which is when a person living in an ordinary home receives support in order to manage that situation.

The home is of fundamental importance for the possibilities for people with SMI to lead an everyday life characterized by meaningful activities, being as this group spend a greater part of their time in the home setting. Activity in one's home is also linked with occupational engagement in other social and geographical contexts. There is a lack of interventions aiming at improving the possibilities for an active and engaged everyday life within the frame of the home setting and the near neighbourhood. The need for support in this field is evident from the research literature, but has also emerged in countless contacts between the investigator's research group and staff working with supported housing and housing support for people with SMI.

The current project is Step two of research aiming to promote meaningful and engaging activities in the home setting for people with SMI in SH, and thereby also support their health, well-being and recovery. Step 1 was a survey of how people with SMI who live in SH, compared to those who receive housing support in an ordinary home, used their time while in their homes and how the participants experienced their opportunities for activity. Findings revealed that the residents had a low activity level and were often alone. The conclusion was that services need to support individually adjusted contextual stimuli and individualize the support to help residents find a good balance and motivate them to be active in and outside SH, which can support a recovery process. Against this background, the aims of Step 2 are to:

• Design an intervention for those who live in SH, on the basis of Step 1 and previous research on activity- and recovery-based interventions, for increasing the residents' opportunities for satisfactory engagement in everyday activities.
• Evaluate the intervention by mixed methods, including an uncontrolled quantitative study and qualitative studies.

Survey of the field Research on SH and housing support for people with SMI has developed during the last years. The focus has been on comparing institutional and community living and on the individual's preferences as to how SH residents wish to live. The participants' views on their living arrangements and on aspects of the physical and psychosocial environments have also been examined. However, research on activities in the home environment has received very little attention in Sweden and internationally, although Priebe et al. reported on how support from the staff was adjusted to promote self-care activities in SH in Great Britain. A small-scale study in Sweden found that rehabilitation, which was based on occupational therapy and client-centeredness and aimed at increased activity in the SH context, resulted in good progress regarding both activity and health-related factors. The improvements were seen to be maintained in a six-month follow-up perspective thus indicating that this was a promising intervention. Only 17 participants were included in that study, however, which makes generalisation impossible.