Experiences of managers and staff working in community-based mental health with people ageing with severe mental health problems.

BACKGROUND: Existing research shows that older people with severe mental health problems need different forms of support in daily life and in the community to lead an active and meaningful life. A common form of support for people with severe mental health problems in Sweden is attendance at community-based day centres (DCs). However, knowledge of staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs is scarce. AIM: The aim was to explore DC staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs during the retirement process. METHOD/PROCEDURE: Telephone interviews were conducted with managers in 27 municipalities in southern Sweden. In addition, focus groups were held with personnel from a total of nine different DCs. The material was analysed using content analysis. RESULTS: The results showed that older people who receive support in community-based mental health care were viewed as a neglected group with complex needs, and the informants (managers and staff) had few policies to guide them when providing support. This made the informants desire more knowledge about best practices to support the target group. One theme emerged, Minding the gap between ideal and reality while working with a neglected group with complex needs, with three categories: Reasoning around unmet needs, Navigating in a muddled organisation, and Wishing for an enriched service. CONCLUSION/PRACTICAL APPLICATION: Together with previous research, the results can contribute to increase awareness about an overlooked group at risk of being neglected and the pitfalls that impact the possibility to guide this target group in their recovery journey. Further research focusing on the target group's own experience of their everyday life situations is also needed.

Experiences of participating in a group-based sensory modulation intervention for mental health service users.

BACKGROUND: People with mental health issues often experience difficulties with sensory modulation affecting occupational engagement. Research conducted in inpatient units has shown positive effects of individual sensory modulation interventions, however, research on experiences of group-based interventions in outpatient units is limited. Hence, a group-based sensory modulation intervention was adapted and tested within Swedish mental health outpatient units. AIM: To explore the experiences of participating in a group-based sensory modulation intervention for service users in mental health outpatient units. MATERIAL AND METHODS: This qualitative study involved interviews with 25 informants who had participated in the intervention. The interview data were analysed using reflexive thematic analysis. RESULTS: Synthesis of the interviews resulted in one overarching theme of 'Embodied awareness facilitates improved coping and sense of self' organised into four themes: (1) 'Developing embodied awareness and strategies', (2) 'Taking control of everyday life', (3) 'Creating a stronger sense of self', and (4) 'From alienation to belonging'. CONCLUSION AND SIGNIFICANCE: The informants experienced the intervention to provide new embodied coping strategies that had previously been neglected. This understanding may enrich occupational therapy practice in new ways to support service users' engagement in occupations.

Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol.

Background: The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods: This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion: The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.

The impact of the BEL intervention on levels of motivation, engagement and recovery in people who attend community mental health services.

BACKGROUND: Community-based day centres (DC) in Sweden provide support to people with severe mental health problems. The role of DC motivation for outcomes in terms of occupational engagement and personal recovery is yet unknown. AIMS: To compare two groups who received DC services, one of which also received the 16-week Balancing Everyday Life (BEL) intervention. The focus was motivation for DC services at baseline and after 16 weeks of services, while also investigating the importance of DC motivation for the selected outcomes and service satisfaction. MATERIAL AND METHODS: Sixty-five DC attendees were randomised to BEL (n = 27) or standard support (n = 38) and responded to questionnaires about motivation, the selected outcomes and satisfaction with DC services. RESULTS: The groups did not differ on any measured aspects of motivation; nor were changes seen over time. The BEL group, but not those receiving standard support, improved from baseline to 16 weeks on occupational engagement and recovery. Motivation for attending the DC was related to service satisfaction. CONCLUSION: The BEL program could be a viable enrichment tool in the DC context and boost occupational engagement and personal recovery among the attendees. SIGNIFICANCE: The study provided knowledge of importance when developing community-based services while enhancing motivation.

Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL).

BACKGROUND: The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context. AIM: The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned. METHODS: This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers. RESULTS: Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation. CONCLUSIONS: Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

Opportunities and barriers for occupational engagement among residents in supported housing.

Opportunities and barriers for occupational engagement among residents in supported housing. BACKGROUND: Research shows that people with psychiatric disabilities view supported housing (SH) as a possibility for social contact, but also as entailing a risk of deprived self-determination. There is, however, little research on the target group's engagement in everyday occupations. AIM: To explore SH residents' opportunities and barriers for occupational engagement. MATERIALS AND METHODS: Sixteen participants were interviewed, and data was analysed using content analysis. RESULTS: An overarching theme, Struggling to create meaning and seeking affection, and three underlying categories, emerged. Finding meaning through self-chosen occupations and support focussed on receiving support, doing self-chosen occupations, and having social contacts. Feeling neglected and insecure limits engagement in occupations was related to feelings of not being seen by staff, and insecurity, which hampered daily life. The third theme was Having a negative self-image and low level of ability hinders an active life. CONCLUSION: Residents' self-view and ability to create an inner drive for being active was important for occupational engagement, which was linked to social connectedness. Occupational based interventions and a personal recovery approach is warranted in order to facilitate needs for meaningful occupations. SIGNIFICANCE: The results from the study can be used to further develop optimal support within SH units.

"It's not just the residents who need to be motivated for activity": a qualitative study of the perspectives of staff on providing activity support for people with psychiatric disabilities in supported housing in Sweden.

Background: The goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents' independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations. Objective: The aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities. Methods: Twenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis. Results: Three main categories emerged from the analysis: Multi-faceted factors influencing the staff's provision of activity support, Staff's approach for supporting activities, and Staff's struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff's ability to motivate to activity. Conclusion: A broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing.

Legitimizing user knowledge in mental health services: Epistemic (in)justice and barriers to knowledge integration.

Including the voices and knowledge of service users is essential for developing recovery-oriented and evidence-based mental health services. Recent studies have however, suggested that challenges remain to the legitimization of user knowledge in practice. To further explore such challenges, a co-production study was conducted by a team of researchers and representatives from user organizations in Sweden. The aim of the study was to explore the barriers and facilitators to the legitimacy of user knowledge, as a central factor in sustainably implementing user influence in mental health practice. A series of workshops, with representatives of mental health services and user organizations were conducted by the research team to explore these issues. The analysis built on the theoretical framework of epistemic injustice, and the underlying aspects, testimonial, hermeneutic and participation-based injustice, were utilized as a framework for a deductive analysis. Results suggest that this is a useful model for exploring the complex dynamics related to the legitimacy of user knowledge in mental health systems. The analysis suggests that the legitimacy of user knowledge is related to the representativeness of the knowledge base, the systematic formulation of this knowledge in applicable methods, access to resources and positions within the mental health system and participation in the process of integrating this knowledge-base in mental health contexts. Legitimizing user knowledge in practice additionally challenges mental health systems to support readiness for change in working environments and to address the power and role issues that these changes involve.

Experiences of sensory input in daily occupations for people with serious mental illness.

BACKGROUND: There is growing evidence that people with serious mental illness have impaired capacity for processing sensory inputs which affects daily occupation. Although this is known, research regarding the target groups experiences of sensory inputs in daily occupations is lacking. AIM: To investigate the experience of sensory input and strategies used in daily occupations among people with serious mental illness. MATERIAL AND METHODS: Fourteen people with serious mental illness were interviewed regarding their experiences of sensory processing and strategies for managing sensory inputs in daily occupations. Data were analysed using content analysis. RESULTS: Sensory processing issues affected occupational engagement and strategies to control inputs were intuitively used to cope with sensory challenges. Informants either ignored, reduced or avoided sensory inputs. Informants also enabled daily life through strategies such as creating a home that provides rest, finding a safe place, using nature and animals for relaxing and using effects of calming and alerting occupations. DISCUSSION: Specific sensory inputs were difficult to process, which was experienced as stressful and affected occupations negatively. The results imply a need for further research exploring the management of sensory input and the use of sensory modulation approaches to enable engagement in daily activities.

An integrated mental health and vocational intervention: A longitudinal study on mental health changes among young adults.

Aim: This study aimed to investigate changes in mental health among young adults participating in an integrated mental health and vocational support intervention according to the Södertälje Supported Employment and Education model. Design: A prospective longitudinal pre-post intervention study of 12 months. Methods: Instruments on depressive symptoms, quality of life, empowerment, engagement in activities and sociodemographic characteristics were administered to 42 young adults aged 19-28 years with mood disorders. Wilcoxon signed rank tests were used to assess changes in mental health. Results: Statistically significant positive changes between baseline and 12 months were noted for quality of life and engagement in activities. Difference in empowerment scores neared significance and a statistical trend towards lower depression scores was seen, corresponding to moderate depression at baseline and less severe depression at 12 months. Conclusions: Integrated mental health and vocational services may support young adults' mental health and is suggested to be linked to their personal recovery and clinical recovery.

A day in the life of people with severe mental illness living in supported housing.

BACKGROUND: People with severe mental illness (SMI) living in supported housing (SH) struggle in everyday life and we currently lack a comprehensive body of knowledge concerning how the residents experience their day. This paper aimed to gain knowledge about how people with SMI describe a day in SH in Sweden, in particular the activities they most frequently engage in and how they experience what they do in or outside their home. Furthermore, it is important to gain knowledge of which activities motivate residents to leave the housing facility and to participate in the community. This new knowledge can help staff to encourage a recovery process among the residents. METHODS: One hundred thirty-three people living in SH completed a time-use diary and a mixed-methods approach was applied, including calculations of what activity that was most frequently performed and a manifest content analysis addressing experiences of activity. RESULTS: The residents had a low activity level and were often alone. Approximately one-half of the reported activities were performed in their own apartments, and generally unaccompanied. A quarter of the activities were performed in the common areas and a further quarter outside the SH. The most frequently performed activities were quiet and tranquil ones, e.g. listening to music and resting. Doing errands and group activities with staff and residents were the main activities that motivated leaving the facility. The participant experience of a day is presented in three categories: "Experiences of chosen and enforced togetherness and overcoming loneliness", "Environmental change and emotional balance can generate activity", and "Met and unmet needs for support, friendship and security". CONCLUSIONS: The residents were generally satisfied with their quiet and tranquil lifestyle and appeared to demand little of life, which may relate to previous experiences of institutional life and can constitute a challenge for staff. The findings highlight experiences that can help to improve SH. 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.

Exploring mediators of the recovery process over time among mental health service users, using a mixed model regression analysis based on cluster RCT data.

BACKGROUND: Personal recovery is associated with many significant health-related factors, but studies exploring associations between activity factors and personal recovery among service users are scarce. The aims of this study were hence to; 1) investigate if various aspects of activity may mediate change in recovery while also acknowledging clinical, sociodemographic and well-being factors; 2) explore the effects of two activity-based interventions, Balancing Everyday Life (BEL) or standard occupational therapy (SOT), on personal recovery among service users. METHODS: Two-hundred-and-twenty-six service users were included in a cluster RCT, 133 from BEL units and 93 from SOT units. Participants commonly had a diagnosis of mood disorder and the mean age was 40. Instruments used targeted activity, mastery and functioning. A mixed-model regression analysis was employed. RESULTS: The model tested was whether selected variables could be used to mediate the change in recovery from the start to a six-month follow-up after intervention. Participants' personal recovery increased after treatment and increased further at the follow-up. The general level of recovery was negatively related to a diagnosis of depression/anxiety, both before and after treatment, but depressed/anxious service users still increased their recovery. There were no significant relations between recovery and sex or age. The interactions between change in recovery and changes in depression/anxiety, satisfaction with activities, sex, and age were all non-significant. All possible treatment mediators included were related to change in recovery, the strongest being occupational engagement and mastery, followed by activity satisfaction and symptoms. Mediation was shown by the decrease in the effect of the time factor (from intervention start to completion) when the covariates were introduced. In all cases the time variable was still significant. When testing a model with all variables simultaneously as covariates, occupational engagement and mastery were strongly significant. There was no difference between interventions regarding recovery improvement. CONCLUSION: The treatments were equally beneficial and were effective regardless of gender, age and diagnosis. Those who gained most from the treatment also gained in feelings of mastery and activity engagement. Activity engagement also moderated the level of recovery. To enhance recovery, interventions should facilitate meaningful activities and gaining control in life. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov . Reg. No. NCT02619318 . Retrospectively registered: December 2, 2015.

Navigating in a Misty Landscape - Perceptions of Supporting a Relative Residing in Supported Housing for People with a Psychiatric Disability.

The aim was to explore informal carers' perceptions of supporting the everyday life of a relative who has a psychiatric disability and resides in supported housing (SH). A qualitative study based on interviews with 12 informal carers was performed, and the data was analyzed with qualitative content analysis. The theme "Navigating in a misty landscape when striving to support a relative with a psychiatric disability" was identified, encompassing four categories pertaining to residents' needs, collaboration, environmental issues and the carer's situation. SH services can be enhanced by addressing informal carers' experiences and developing greater collaboration involving informal carers, residents and staff.

Group leader and participant perceptions of Balancing Everyday Life, a group-based lifestyle intervention for mental health service users.

Background: There exist few recovery and occupation-based interventions for mental health service users. Balancing Everyday Life (BEL) is a new occupation-based lifestyle intervention that was created to fill this need.Aim: To gain group leaders' and participants' perspectives of the BEL intervention content and format, including factors that helped, hindered, and could be improved.Methods: A constructivist grounded theory method guided data collection and analysis. Interviews took place with 12 BEL group leaders and 19 BEL participants from out-patient psychiatry settings and community-based day centers in Sweden.Results: BEL's structure and content were appreciated, yet flexibility was desired to adapt to participant needs. BEL could act as a bridge, helping participants connect with others, and to a more engaged and balanced everyday life. Facilitating factors included a person-focused (versus illness-focused) approach, physical and emotional environments, and connection. Barriers included room resources. More sessions were desired for the intervention.Conclusion: Group leaders and participants experienced BEL as a useful tool to instigate meaningful change and connection in the participants' lives. The combination of a positive person-focused approach and group support was appreciated. These results could inform future research, evaluation, and development of occupation-focused lifestyle interventions for mental health service users.

Perceived occupational balance and well-being among people with mental illness living in two types of supported housing.

Background: People with psychiatric disabilities often struggle with maintaining a satisfying occupational balance. Knowledge about factors of relevance for occupational balance in this group is therefore vital for improving their support.Aim: The aim was to describe perceptions of occupational balance among people with psychiatric disabilities living in supported housing (SH) or in own flat/house with housing support (OHS). Potential importance of housing context and socio-demographic, well-being and recovery factors for occupational balance was also explored.Methods: Participants from SH (N = 155) and OHS (N = 111) responded to questionnaires about sociodemographic situation, well-being (self-rated health, life satisfaction and self-mastery), personal recovery and occupational balance (work, leisure, home chores, self-care and general balance assessed by SDO-OB).Results: A majority in both groups reported being in balance regarding all five domains of occupational balance. The OHS group reported being more under-occupied for home chores and self-care. Self-mastery was the most important contributor in both groups in the domains of work, domestic chores and self-care. Day center attendance was vital for general occupational balance.Conclusion: Both groups generally perceived occupational balance. Control over one's life situation and possibilities for regularly participating in occupations outside the home environment should receive high priority in housing support.

Predictors of clinically important improvements in occupational and quality of life outcomes among mental health service users after completion and follow-up of a lifestyle intervention: multiple regression modelling based on longitudinal data.

BACKGROUND: Balancing Everyday Life (BEL) is a new activity-based lifestyle intervention for mental health service users. An earlier study found BEL to be effective in increasing occupational engagement, occupational balance, activity level, and quality of life scores when compared with a care-as-usual group. However, it is unclear whether care context and socio-demographic, clinical and self-related factors at baseline also influence the results. Thus, the aim of the current study was to explore whether such factors could predict clinically important improvements in occupational and quality of life aspects. METHODS: Participants were interviewed and filled out self-report questionnaires before starting the 16-week intervention (n = 133), upon completion (n = 100), and 6 months following (n = 89). Bi-variate and multi-variate statistical analyses were performed. RESULTS: Several baseline factors were associated with clinically important improvements, but few predictors were found in the multivariate analyses. Having children was found to be a predictor of improvement in occupational engagement at BEL completion, but reduced the chance of belonging to the group with clinically important improvement in activity level at follow-up. Regarding occupational balance, having a close friend predicted belonging to the group with clinically important improvement in the leisure domain. At BEL completion, other predictors for improvements were female gender for the self-care domain, and self-esteem for the home chores domain. At follow-up, psychosocial functioning and lower education level predicted general balance. None of the factors explored in this study were found to be predictors for improvements in quality of life. CONCLUSIONS: Few of the studied care context, socio-demographic, clinical and self-related factors were found to predict clinically important improvements in occupational engagement, activity level, occupational balance, or QOL. This study, together with previous studies showing positive results, suggests that BEL can be an appropriate intervention in both community and clinical settings, and can support improvement in occupational aspects and QOL for participants with diverse socio-demographic, clinical, and self-related characteristics. TRIAL REGISTRATION: This study is part of a larger research project that is registered at ClinicalTrials.gov. Reg. No. NCT02619318.

Breaking a cycle of perceived failure: The process of making changes toward a more balanced lifestyle.

INTRODUCTION: Balancing Everyday Life (BEL) is a new lifestyle intervention for mental health services users, developed to support meaningful engagement in daily activities and a balanced lifestyle. This study aimed at exploring the BEL participants' process of making lifestyle changes. METHODS: This constructivist grounded theory study took place in Sweden from 2013-2017 and explored the processes of 19 BEL participants when making lifestyle changes. Data were collected through 29 interviews. RESULTS: A process of breaking a cycle of perceived failure and making changes toward a more balanced lifestyle was constructed, consisting of five categories: Going at it gently: change is an on-going process; Support for progress, permission to fail; Prioritising and setting boundaries; Adjusting for a sustainable balance; and Caring for a valued self. Each category included a strategy for change as well as a related inner change. Strategies involved learning and trying techniques for making changes toward a more balanced lifestyle, whereas the personal changes often involved a more self-compassionate approach and allowing oneself to utilise these techniques. CONCLUSION: The results contribute to knowledge in the process of making lifestyle changes, specifically, how strategies for change and inner changes interact and can support personal recovery toward mental health. This knowledge could help to support clients in making personally meaningful changes toward a more balanced lifestyle as well as inform future research in the process of making change.

Joining, belonging, and re-valuing: A process of meaning-making through group participation in a mental health lifestyle intervention.

BACKGROUND: Balancing Everyday Life (BEL), a new group-based intervention for mental health service users, was implemented in Sweden. Mental health service users often experience group interventions as meaningful, but knowledge of the process of meaning-making in a group is lacking. AIM: To explore participants' perceptions of the group in the Balancing Everyday Life (BEL) lifestyle intervention; specifically, personal experiences of what brings meaning when participating in a group. METHODS: This qualitative Grounded Theory study included 26 interviews with 19 BEL participants. RESULTS: A process of meaning-making in a group was constructed: Joining with others: from feeling alone to connected, A sense of belonging: mutual support and understanding, and Re-valuing Self: respect and self-worth. No longer feeling alone contributed to meaning. Peers and group leaders were considered important parts of the group, and participants appreciated feeling understood, respected, and helping others. CONCLUSION: The proposed process of meaning-making, as well as 'Joining' as a unique step, seems to be new contributions which could help practitioners when organizing groups. Overcoming fear of joining could break a cycle of isolation and lead to connecting and belonging. The value of participants finding purpose through helping others should be further explored.

Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study.

BACKGROUND: Many with a mental illness have an impoverished everyday life with few meaningful activities and a sedentary lifestyle. The study aim was to evaluate the effectiveness of the 16-week Balancing Everyday Life (BEL) program, compared to care as usual (CAU), for people with mental illness in specialized and community-based psychiatric services. The main outcomes concerned different aspects of subjectively evaluated everyday activities, in terms of the engagement and satisfaction they bring, balance among activities, and activity level. Secondary outcomes pertained to various facets of well-being and functioning. It was hypothesized that those who received the BEL intervention would improve more than the comparison group regarding activity, well-being and functioning outcomes. METHODS: BEL is a group and activity-based lifestyle intervention. CAU entailed active support, mainly standard occupational therapy. The BEL group included 133 participants and the CAU group 93. They completed self-report questionnaires targeting activity and well-being on three occasions - at baseline, after completed intervention (at 16 weeks) and at a six-month follow-up. A research assistant rated the participants' level of functioning and symptom severity on the same occasions. Non-parametric statistics were used since these instruments produced ordinal data. RESULTS: The BEL group improved more than the CAU group from baseline to 16 weeks on primary outcomes in terms of activity engagement (p < 0.001), activity level (p = 0.036) and activity balance (p < 0.042). The BEL group also improved more on the secondary outcomes of symptom severity (p < 0.018) and level of functioning (p < 0.046) from baseline to 16 weeks, but not on well-being. High intra-class correlations (0.12-0.22) indicated clustering effects for symptom severity and level of functioning. The group differences on activity engagement (p = 0.001) and activity level (p = 0.007) remained at the follow-up. The BEL group also improved their well-being (quality of life) more than the CAU group from baseline to the follow-up (p = 0.049). No differences were found at that time for activity balance, level of functioning and symptom severity. CONCLUSION: The BEL program was effective compared to CAU in terms of activity engagement. Their improvements were not, however, greater concerning other subjective perceptions, such as satisfaction with daily activities and self-rated health, and clustering effects lowered the dependability regarding findings of improvements on symptoms and functioning. Although the CAU group had "caught up" at the follow-up, the BEL group had improved more on general quality of life. BEL appeared to be important in shortening the time required for participants to develop their engagement in activity and in attaining improved quality of life in a follow-up perspective. TRIAL REGISTRATION: The study was registered with ClinicalTrial.gov. Reg. No. NCT02619318 .

Wellbeing, activity and housing satisfaction - comparing residents with psychiatric disabilities in supported housing and ordinary housing with support.

BACKGROUND: The home is imperative for the possibilities for meaningful everyday activities among people with psychiatric disabilities. Knowledge of whether such possibilities vary with type of housing and housing support might reveal areas for improved support. We aimed to compare people with psychiatric disabilities living in supported housing (SH) and ordinary housing with support (OHS) regarding perceived well-being, engaging and satisfying everyday activities, and perceived meaning of activity in one's accommodation. The importance of these factors and socio-demographics for satisfaction with housing was also explored. METHODS: This naturalistic cross-sectional study was conducted in municipalities and city districts (n = 21) in Sweden, and 155 SH residents and 111 OHS residents participated in an interview that included both self-reports and interviewer ratings. T-test and linear regression analysis were used. RESULTS: The SH group expressed more psychological problems, but better health, quality of life and personal recovery compared to the OHS residents. The latter were rated as having less symptom severity, and higher levels of functioning and activity engagement. Both groups rated themselves as under-occupied in the domains of work, leisure, home management and self-care, but the SH residents less so regarding home management and self-care chores. Although the groups reported similar levels of activity, the SH group were more satisfied with everyday activities and rated their housing higher on possibilities for social interaction and personal development. The groups did not differ on access to activity in their homes. The participants generally reported sufficient access to activity, social interaction and personal development, but those who wanted more personal development in the OHS group outnumbered those who stated they received enough. Higher scores on satisfaction with daily occupations, access to organization and information, wanting more social interaction, and personal recovery predicted high satisfaction with housing in the regression model. CONCLUSION: The fact that health, quality of life and recovery were rated higher by the SH group, despite lower interviewer-ratings on symptoms and level of functioning, might partly be explained by better access to social interaction and personal development in the SH context. This should be acknowledged when planning the support to people who receive OHS.