Perceptions and Realities : Exploring Homelessness and Substance Use through Professional and Lived Experience Lenses

Chapman-Brook, Amy and Klein, Maike (2025) Perceptions and Realities : Exploring Homelessness and Substance Use through Professional and Lived Experience Lenses. PhD thesis, Lancaster University.

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Abstract

This thesis comprises of a systematic literature review (SLR), an empirical research paper (ERP), and a critical appraisal (CA). The SLR presents a meta-ethnography which explored the perspectives of health and social care professionals working with individuals who experience homelessness and substance use. Findings suggested that professionals navigate their roles within the constraints of under-resourced and fragmented systems. Rather than solely reflecting individual bias, negative attitudes were frequently linked to structural limitations, organisational pressures, and a sense of risk and uncertainty. Within this context, empathy emerged as a key factor in maintaining compassionate and humanised care, even when professionals felt unsupported. The ERP presents a reflective thematic analysis, exploring the conceptualisation of recovery from substance use among people experiencing homelessness. While participants echoed wider understandings of recovery as an ongoing journey and personal transformation, their experiences also revealed unique challenges shaped by homelessness. Stable housing was described as a foundational requirement for recovery, with temporary accommodations often acting as barriers due to instability and exposure to substance use. Access to recovery services was limited and often reliant on informal networks, with outreach workers playing a critical bridging role. Systemic fragmentation, particularly the lack of integration between housing and substance use services, was identified as a major obstacle, reinforcing cycles of exclusion. The CA offers reflections on methodological and ethical aspects of the research process and highlights how conceptual ambiguities influence research design, interpretation, and applicability of findings to service contexts.