Maslow and mental health recovery: A comparative study of homeless programs for adults with serious mental illness

Maslow's hierarchy of needs posits having one's basic needs met as a necessary prerequisite to pursuing a fulfilling life. This paper applies Maslow's theory to understanding recovery among adults with serious mental illness who have experienced chronic homelessness in order to consider whether meeting one's basic need for housing makes the pursuit of recovery more likely and whether a continued focus on obtaining permanent housing precludes its pursuit. We compare self-reported needs and goals of 57 individuals enrolled in two distinct program service models; “housing first” (HF) “treatment first” (TF). Comparisons of individuals in these two groups were made upon intake to the programs and at 12-month follow-up. Several hypotheses are tested based on a Maslovian pyramid where individuals progress through lower level needs and goals at the base of the pyramid toward self-actualization, or recovery, at the top of the pyramid. Results indicate that addressing one's basic need of shelter through permanent housing was associated with significantly higher self-reported goals at the top of the pyramid, seen in the HF group at baseline and in both groups at follow up. For the TF group, a decline in the self-reported need for housing was disproportionately smaller than the decline in the self-reported pursuit of housing, indicating needs do not necessarily drive the pursuit of goals. Invoking Maslow as an intuitive approach to help guide mental health and social service policy can be useful but risks understating the complex relationship between an individual's environment, identifiable needs, and the pursuit of goals.