Introduction: Citizenship and citizenship-oriented care

Citizenship as understood and evaluated by the editors of this special issue and several authors of the articles included here, is defined as the person’s strong connection to the 5 Rs of rights, responsibilities, roles, resources, and relationships that society makes available to its members through public and social institutions and association life, and a sense of belonging that is validated by others (Rowe, 2015). The citizenship framework was inspired by the limitations of mental health outreach to person who are homeless. In that work, outreach workers and case managers found and built with relationships with their clients and, after mutual trust was built, offered them a broad range of services—mental health and primary care, access to income through disability entitlements or employment, and access to housing. Outreach work, though it developed independently of the recovery movement during the 1990s, was characterized by person-first and strengths-based values that are consistent with those of recovery.

The problem occurred when people were housed. Some felt so isolated in their apartments and so out of place with others around them that they considered moving back to the streets where they had friends, knew what to do, and shared with others the valued role of being one who could survive homelessness. Outreach workers and teams, then, could provide services and treatment that would equip people for “a life in the community” in all areas but the identity of being a member of that community. And the problem wasn’t confined to outreach. Citizenship might have been inspired by jail diversion services, assertive community treatment, or even a Housing First approach. The outreach team lived at the margins of the mental health system of care, but it was a part of a system that, in placed of full, valued, and participating citizenship, could offer only a bounded or program citizenship.

Citizenship work over the past 20 years was developed iteratively. A community coalition of people who were or had been homeless, mental health providers of care, and other community members demonstrated that such a coalition could be formed and undertake meaningful education and networking actions. It was not equipped nor oriented to the challenge of helping individuals—homeless, with incarceration histories, or otherwise excluded by mental illness and poverty, to achieve full citizenship. An individual and group citizenship-based intervention could, however, demonstrate good clinical and community outcomes for participants. What it could not do, though it gave intimations of it, was to show that it enhanced participants’ citizenship. This led to development of an individual measure of citizenship through community-based participatory and concept mapping methods (O’Connell, Clayton, & Rowe, 2017). Equipped with rationale, definition, pilot community, and individual and small-group interventions, and a way to measure changes in citizenship, the framework was ready to expand it work in two directions—one reaching in to clinical care to develop “citizenship-informed care,” and the other in the direction of individual and collective neighborhood and community interventions and networking that would deepen and expand the reach and promise of citizenship work. Several of the articles in this special issue reflect the initial work of this dual approach.