Michael Rowe, PhD

Overview of Mental Health Research and Scholarship

Mental health outreach to persons who are homeless/unhoused

My research in psychiatry from 1994 to 2000 is linked with my leadership and study of a mental health outreach team for the Connecticut Mental Health Center and several community-based agencies, under the leadership of the Connecticut Department of Mental Health and Addiction Services/DMHAS. Connecticut was one of 18 sites nationally of a federal Substance Abuse and Mental Health Services/SAMHSA program aimed at ending homelessness among people with mental illnesses and providing comprehensive care and supports for them within mental health systems of care.

In mental health outreach work, clinicians, case managers, and other specialists leave their offices to meet and build trust with people who may initially avoid them, due to their previous negative experiences with mental health care. Outreach workers proceed at their prospective clients’ pace, building trust with them and gradually introducing services and supports including primary care, access to entitlement income or employment, housing, and mental health care.

I came to see the encounters between people who were homeless/unhoused and outreach workers as social encounters taking place at the psychological, social and economic, and physical boundaries of local communities and society. These encounters involve transactions and negotiations over instrumental goods such as housing and income, and affective goods such as personal identity and place in society. The clinical aspect of these encounters is critical but not dominant. I wrote of this work in Crossing the Border: Encounters Between Homeless People and Outreach Workers (University of California Press, 1999) and many peer-reviewed articles.

Citizenship and Mental Health

In my study of mental health outreach work I came to see that, while outreach workers helped their clients gain access to health care and other resources, they also were part of an institutional response that conferred upon its clients the status of “program citizenship,” with dependence on mental health systems of care. This view led me to develop an applied framework of citizenship to support the inclusion and full membership in society of persons with mental health challenges, including but not limited to people who were homeless.

I define citizenship as a person’s, or people’s, strong connection to the 5 R’s of rights, responsibilities, roles, resources, and relationships that society offers its members, and a sense of belonging that is validated by other citizens. I contend that the individual and collective achievement of this goal will fulfill the promise of “a life in the community” and society envisioned in the report of the Eisenhower Commission on Mental Health in the 1950s, and in the goals of the Community Mental Health Movement starting in the 1960s.

With funding from NIMH, the Connecticut Department of Mental Health and Addiction Services/DMHAS, and other sources, my applied research with colleagues on the citizenship framework has included:

• A community-based citizenship group intervention—The Citizens Project—with findings from a randomized clinical trial of reduced substance and alcohol use and increased quality of life for citizenship participants, compared to those receiving usual care;
• Development and validation of an individual measure of citizenship for people with mental health challenges;
• Development of the concept of “recovering citizenship,” which contends that recovery is achieved in the context of one’s achievement of full citizenship;
• Training for clinicians to employ the citizenship model in their work;
• Development of a “collective citizenship” approach with group support and advocacy by persons with mental health challenges and others, both at and beyond the borders of mental health systems of care;
• Implementation of a DMHAS-funded statewide initiative—the Recovering Citizenship Learning Collaborative—to offer statewide training on citizenship-based care and supports for DMHAS-funded mental health centers and clinics; and
• Implementation, with DMHAS support, for the International Recovery and Citizenship Collective, with membership from 11 countries and growing, to support co-learning and knowledge exchange, training, program implementation, and research.

Peer-Based Supports and Peers as Staff in Mental Health and Social Support Programs

My work with colleagues on deployment of peers as staff and as researchers in citizenship interventions and study has included the Citizens Project, individual measure development, and collective citizenship. Validation of this work has stemmed in part from a randomized clinical trial for which I was the PI, involving four DMHAS-funded clinical programs. We found that peer staff have a unique capacity to support people’s engagement into treatment and self-help groups such as AA and NA. We also found that clients responded more positively to the “unconditional regard” of peer staff than to that from non-peer staff. They also accepted “negative regard,” or criticism, from peer staff more readily than that from non-peer staff.

Medical Humanities and Narrative Medicine

My research and writing in the fields of bioethics and narrative medicine are mainly distinct from my research and writing in mental health. A thread that runs through both domains, however, is the relationship between patients (or clients) and caregivers—doctors, clinicians, and others—and the professional, social, and institutional settings within which care occurs. I have conducted research and scholarship, along with non-academic writing, in the areas of narrative medicine, patient–doctor relationships, long-term illness, and the promise and risks of high-technology medicine. My writing in these areas has included peer-reviewed articles, an edited volume on medical errors in oncology, and a narrative nonfiction account of organ transplantation, medical mishaps, and grief.

Selected Research Grants (in addition to those included in grants)

European Commission, Marie Skłodowska-Curie, MCSA: H2020-MSCA-RISE-2015: H2020-MSCA-RISE-2015, Research Innovation Staff Exchange: Citizenship, Recovery and Inclusive Society Partnership. PI: Neil Quinn, Ph.D. Role on project: PI for Yale partnership with University of Strathclyde, 2016–2019

NIMH: R34 #MH107633-01: Financial and Mental Health: Exploratory Research and Model Development. PI: Michael Rowe, Ph.D., 2015–2017

NIMH: R01 #MH091453: Effectiveness and Cost-Effectiveness of Peer Mentors in Reducing Hospital Use. PI: Larry Davidson, Ph.D. Role on Project: Co-Investigator, 2010–2014

NIMH: R34 #MH083394-01A2: Benefits Management for People with Psychiatric Disabilities. PI: Marc Rosen, M.D. Role on Project: Co-Investigator, 2011–2013

NIMH: R21 #MH 087762-01: Social Inclusion and Mental Illness: Outcome Measure Development. PI: Michael Rowe, Ph.D., 2010–2012

Professional Service

Peer Review Groups/Grant Study Sections

Investigator, WHO-CC in Lille, Revision of the International Classification of Diseases

Member, Technical Panel for the National Evaluation of SAMHSA’s Homeless Programs

Member, Scientific Committee, 4^th International WHO-CC Meeting, “How to Promote Empowerment Experiences for Mental Health Users and Carers in Europe.”

Member, Scientific Committee on Housing First, French Ministry of Health

Journal Service

Editor-in-Chief, The Perch: An Arts & Literary Journal

Member, Editorial Board, Medical Humanities (BMJ Group)

Selected Research and Scholarly Presentations, National and International

2023 Recovering Citizenship. Asia Pacific International Mental Wellness Conference 2023, Hong Kong (Keynote)

Citizenship and the Right to Have Rights. SKANROP 2023, Addiction and Mental Disorders in Life course: Transitions and Solutions, Scandic Hotel, Hamar, Norway (Keynote)

2021 Meeting Jim: The Origins of Citizenship. SAMHSA Mental Health Technology Transfer Center (MHTTC) Network (Keynote, Virtual)

2020 Recovering Citizenship. DMHAS Statewide Kickoff Event for the Recovering Citizenship Learning Collaborative (Keynote)

2019 Citizenship and Mental Health. Creating an Inclusive Society: Transatlantic Perspectives, University of Strathclyde, Glasgow, Scotland (Keynote)

Citizenship and Mental Health. Refocus on Recovery 2019, Nottingham University, Nottingham, England (Speaker)

2018 Citizenship and Mental Health. Hiram College, Hiram, OH (Morgan Clark Lecture)

The Citizens Project: Beginnings. Healthy Futures: Inclusion, Inspiration, and Integration, 13^th Biennial Asia Pacific International Mental Health and Addiction Conference, New Zealand (Speaker)

Citizenship and Mental Health. Austen Riggs Center, Stockbridge, MA, Grand Rounds (Lecture)

2017 Citizenship: An Exploration. International Festival of Arts and Ideas, New Haven, CT (Chair/Moderator, Panel Discussion)

2016 Citizenship. A Transatlantic Mental Health Policy Symposium, Moving Towards Inclusion: Solutions from the U.S. and Europe, New York University, New York, NY (Breakout Session)

2015 How the Mental Health and Criminal Justice Systems Collaborate to Support Recovery. Reinforcing Recovery, Delaware County conference, Magellan, Inc. and Peerstar, Inc., Philadelphia, PA (Keynote, with Chyrell Bellamy, Ph.D.)

Citizenship and Human Rights. School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland (Keynote)

2014 Citizenship: Does It Support Recovery for People with Mental Illnesses? Psychosocial rehabilitation and recovery symposium: Theoretical and methodological approaches in the Anglo-Saxon and Brazilian traditions, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil (Keynote)

2013 What Narrative, and Whose? Adventures in Mental Health, Criminal Justice and Community-Based Participatory Research. Narrative in the Age of Distraction, Wesleyan University, Middletown, CT (Speaker)

2012 Mad Positive in the Academy: An International Dialogue on Practice. Ryerson University, Toronto, Canada (Faculty)

Why People Don’t Sue: A Qualitative Inquiry. Medical Errors in Cancer Care: Prevention, Disclosure, and Patient and Family Member Responses (Core Session), American Society of Clinical Oncology, ASCO Annual Meeting, Chicago, IL (Speaker)

2011 Going to the Source: Outcome Measure Development. Symposium on Social Integration of Persons with Mental Illnesses, Mailman School of Public Health, Columbia University, New York, NY (Speaker)

The Social Foundation of Public Mental Health. The Second International Congress of Integrative and Expert Psychiatry: The Multidimensionality of Psychiatric Care: Models of Community-based Psychiatric Care, Macro-Mod Project, Iaşi, Romania (Keynote)

2010 Recovering at the Back of the Bus. Public Policy Network Meeting, University of Edinburgh, Edinburgh, Scotland (Speaker)

Citizenship and Agency in the Context of Intensive Case Management Services. Mental Health Recovery: Practice, Services and Research, New York University, New York, NY (Speaker)

2009 Citizenship and Mental Illness. Center for the Study of Recovery in Social Contexts Seminar, Nathan Kline Institute, New York, NY (Speaker)

Mental Health Outreach and Citizenship for Persons with Mental Illness Who Are Homeless. Recovery: A Model for Addressing the Health Care Needs of People who are Homeless, Ministry of Health, Paris, France (Speaker)

2008 Mental Illness, Recovery, and Citizenship. Conference on Psychosocial Rehabilitation: Change the Thinking, Change the Practice, Change the System, Copenhagen, Denmark (Speaker)

Citizenship, Homelessness, and Mental Illness. City of the Associations, Marseille, France (Keynote)

2007 Consumer Integration and Self-Determination in Homelessness Research, Policy, Planning, and Services. National Symposium on Homelessness, U.S. Departments of Health and Human Services and Housing and Urban Development, Washington, DC (Speaker)

Voices, Capabilities, and Citizenship. Living with Dignity as a Member of One’s Community, 7th Annual Training Conference for State and Territory Mental Health Olmstead Coordinators, SAMHSA, Washington, DC (Speaker)

2006 Looking inside the Black Box: How Peer Support Differs from Case Management. Sixteenth Annual Conference on State Mental Health Agency Services Research, Program Evaluation, and Policy Directors, Baltimore, MD (Speaker)

A Foot in Each World: Crossing Boundaries between Universities and Civil Society. The University and Civil Society: Autonomy and Responsibility, Denver University–Bologna International Center for Civic Engagement, University of Bologna, Bologna, Italy (Presenter)

2005 Medical Errors in Oncology: Patients’ and Physicians’ Attitudes and Management Strategies. Annual Meeting, American Society of Clinical Oncology, Orlando, FL (Co-Chair, Educational Session)

Doctors’ Responses to Medical Errors and Their Contexts. Medical Errors in Oncology: Patients’ and Physicians’ Attitudes and Management Strategies, Annual Meeting, American Society of Clinical Oncology, Orlando, FL (Speaker)

2004 Witnessing the Moment. International Congress on Care of the Terminally Ill, Montreal, Canada (Speaker)

Illness, Recovery, and the Grotesque. Narrative Medicine Rounds, College of Physicians and Surgeons of Columbia University, Narrative Medicine, New York, NY (Co-Keynote)

2003 Medicine, Mortality, and Children. Pediatric Resident Grand Rounds, University of Rochester School of Medicine, Rochester, NY (Speaker)

Crossing Borders in Research and Practice: The Risks and Opportunities of Participant Research. Joint Session of Social Work Research Classes, University of Pennsylvania, School of Social Work, Philadelphia, PA (Keynote)

2002 Choice and Coercion in Public Mental Health Practice: Peer Outreach as an Alternative to Involuntary Outpatient Treatment. American Sociological Association Annual Meeting (Presenter)

Engaging Homeless Persons with Substance Use: Applications from Mental Health Outreach. Institute on Psychiatric Services, American Psychiatric Association (Presenter)

2001 Enhanced Jail Diversion: Treating beyond Referral. American Academy of Psychiatry and the Law Annual Meeting, Boston, MA (Presenter)

2000 The Outreach Worker’s Dilemma. 52^nd Institute on Psychiatric Services, American Psychiatric Association (Presenter)

1999 A New Dimension in Response to Homelessness. 7th Biennial Conference, Society for Community Research and Action (Presenter)

1997 The Street-Level Integration of Services for Mentally Ill Homeless Persons. American Orthopsychiatric Association Annual Meeting (Presenter)

Career highlight peer-reviewed articles, book chapters, and books (in addition to/along with Publications section)

1. Rowe, M., Hoge, M. A., & Fisk, D. (1996). Critical issues in serving people who are homeless and mentally ill. Administration and Policy in Mental Health and Mental Health Services Research, 23(6), 555–565. https://psycnet.apa.org/doi/10.1007/BF02108691
2. Rowe, M., Hoge, M. A., & Fisk, D. (1998). Services for mentally ill homeless persons: Street-level integration. American Journal of Orthopsychiatry, 68(3), 490–496. https://psycnet.apa.org/doi/10.1037/h0080358
3. Rowe, M. (1999). Crossing the border: Encounters between homeless people and outreach workers. University of California Press. https://cir.nii.ac.jp/crid/1130282268794557056
4. Rowe, M., Kloos, B., Chinman, M., Davidson, L., & Cross, A. B. (2001). Homelessness, mental illness, and citizenship. Social Policy and Administration, 35(1), 14–31. https://doi.org/10.1111/1467-9515.00217
5. Rowe, M. (2002). Metamorphosis: Defending the human. Literature and Medicine, 21(2), 264–280. https://doi.org/10.1353/lm.2002.0024
6. Rowe, M. (2002). The rest is silence. Health Affairs, 21(4), 232–236. https://doi.org/10.1377/hlthaff.21.4.232
7. Rowe, M. (2002). The book of Jesse: A story of youth, illness, and medicine (J. Harlan-Rowe, Illus.). The Francis Press. https://repository.library.georgetown.edu/handle/10822/951555
8. Rowe, M., Frey, J., Bailey, M., Fisk, D., & Davidson, L. (2002). Clinical responsibility and client autonomy: Dilemmas in mental health work at the margins. American Journal of Orthopsychiatry, 71(4), 400–407. https://psycnet.apa.org/doi/10.1037/0002-9432.71.4.400
9. Rowe, M. (2003). The structure of the situation: A narrative on high-intensity medical care. The Hastings Center Report, 33(6), 37–44. https://doi.org/10.2307/3527824
10. Rowe, M. Doctors’ responses to medical errors. (2004). Critical Reviews in Oncology/Hematology, 52(3), 147–163. https://doi.org/10.1016/j.critrevonc.2004.06.003
11. Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the field. Schizophrenia Bulletin, 32(3), 443–450. https://doi.org/10.1093/schbul/sbj043
12. Sells, D., Davidson, L., Jewell, C., Falzer, P., & Rowe, M. (2006). The treatment relationship in peer-based and regular case management services for clients with severe mental illness. Psychiatric Services, 57(8), 1179–1184. https://doi.org/10.1176/ps.2006.57.8.1179
13. Davidson, L., Rowe, M., Tondora, J., O’Connell, M. J., & Lawless, M. S. (2008). A practical guide to recovery-oriented practice: Tools for transforming mental health care. Oxford University Press. https://doi.org/10.1093/oso/9780195304770.001.0001
14. Rowe, M., Lawless, M., Thompson, K., & Davidson, L. (Eds.). (2011). Classics of community psychiatry: Fifty years of public mental health outside the hospital. Oxford University Press. https://doi.org/10.1192/bjp.bp.111.107276
15. Rowe, M., Clayton, A., Benedict, P., Bellamy, C., Antunes, K., Miller, R., Pelletier, J.-F., Stern, E., & O’Connell, M. J. (2012). Going to the source: Citizenship outcome measure development. Psychiatric Services, 63(5), 45–50. https://doi.org/10.1176/appi.ps.201100272
16. Clayton, A., O’Connell, M. J., Bellamy, C., Benedict, P., & Rowe, M. (2013). The citizenship project, part II: Impact of a citizenship intervention on clinical and community outcomes for persons with mental illness and criminal justice charges. American Journal of Community Psychology, 51(1–2), 114–122. https://doi.org/10.1007/s10464-012-9549-z
17. Rowe, M. (2014). Community psychiatry and the medical humanities. In T. Jones, L. Friedman, & D. Wear (Eds.), Health humanities reader (pp. 330–340). Rutgers University Press.
18. Rowe, M. (2015). Citizenship and mental health. Oxford University Press. https://psycnet.apa.org/record/2015-18571-000
19. Harper, A., Clayton, A., Bailey, M., Foss-Kelly, L., Sernyak, M. J., & Rowe, M. (2015). Financial health and mental health among clients of a community mental health center: Making the connections. Psychiatric Services, 66(12), 1271–1276. https://doi.org/10.1176/appi.ps.201400438
20. Ponce, A. N., Clayton, A., Gambino, M., & Rowe, M. (2016). Social and clinical dimensions of citizenship from the mental health-care provider perspective. Psychiatric Rehabilitation Journal, 39(2), 161–166. https://psycnet.apa.org/doi/10.1037/prj0000194
21. Rowe, M., & Davidson, L. (2016). Recovering citizenship. Israel Journal of Psychiatry and Related Sciences, 53(1), 14–21. https://pubmed.ncbi.nlm.nih.gov/28856875/
22. Eiroa-Orosa, F. J., & Rowe, M. (2017). Taking the concept of citizenship in mental health across countries. Reflections on transferring principles and practice to different sociocultural contexts. Frontiers in Psychology, 8, 1020. https://doi.org/10.3389/fpsyg.2017.01020
23. MacIntyre, G., Cogan, N., Stewart, A., Quinn, N., Rowe, M., & O’Connell, M. (2018). Understanding citizenship within a health and social care context in Scotland using community based participatory research methods. SAGE Research Methods Cases. https://doi.org/10.4135/9781526484918
24. Ponce, A. N., & Rowe, M. (2018). Citizenship and community mental health care. American Journal of Community Psychology, 61(1–2), 22–31. https://psycnet.apa.org/doi/10.1002/ajcp.12218
25. Hamer, H. P., Rowe, M., & Seymour, C. A. (2019). The right thing to do: Fostering social inclusion for mental health service users through acts of citizenship. International Journal of Mental Health Nursing, 28(1), 297–305. https://doi.org/10.1111/inm.12533
26. Quinn, N., Bromage, B., & Rowe, M. (2020). Collective citizenship: From citizenship and mental health to citizenship and solidarity. Social Policy and Administration, 54(3), 361–374. https://doi.org/10.1111/spol.12551
27. Flanagan, E., Tondora, J., Harper, A., Benedict, P., Giard, J., Bromage, B., Williamson, B., Acker, P., Bragg, C., Adams, V., & Rowe, M. (2023). The Recovering Citizenship Learning Collaborative: A system-wide intervention to increase citizenship practices and outcomes. Journal of Public Mental Health, 22(3), 127–132. https://doi.org/10.1108/JPMH-12-2022-0125
28. Surbone, A., & Rowe, M. (Eds.). (2015). Clinical oncology and error reduction. John Wiley & Sons. https://library.wur.nl/WebQuery/titel/2218465
29. Rowe, M., & Barber, C. (2018, June 4). Not just a place to live: From homelessness to citizenship. The Conversation. https://theconversation.com/not-just-a-place-to-live-from-homelessness-to-citizenship-97170
30. Rowe, M., & Ponce, A. N. (2020). How shall we promote citizenship and social participation? In H. H. Goldman R. G. Frank, & J. P. Morrissey (Eds.), The Palgrave handbook of American mental health policy (pp. 573–599). Palgrave Macmillan. https://link.springer.com/chapter/10.1007/978-3-030-11908-9_20
31. Eiroa-Orosa, F. J., MacIntyre, G., & Rowe M. Routledge International Handbook of Citizenship and Community Mental. Routledge/Taylor & Francis Group. In preparation, 2027.
32. Ponce, A. N., & Rowe, M. (2020). How shall we promote citizenship and social participation? In H. H. Goldman, M. Horvitz-Lennon, J. Breslaud, R. G. Frank, & J. P. Morrissey (Eds.), The Palgrave handbook of American mental health policy (pp. 573–599). Palgrave Macmillan, 2^nd Edition, In press.