Almost thirty years ago, a graduate student named Michael Rowe peered deeply into the work of his “homeless outreach” team.
This month, on the eve of his retirement, he recalled that experience in our conversation over Zoom. It wasn’t his first time running a social service program, but it would be his most consequential, leading to a cascade of ideas and innovations in the mental health field, drawing people around the world into new realms of understanding about mental health recovery.
Beginnings
After graduating from college, Rowe, who grew up in the gritty city of Rochester, New York, had directed agencies in New Haven during the tough Reagan years of the 1980s, when the government slashed funding for social services and homelessness soared. After earning his master’s in public administration at the University of Hartford, he’d decided to pursue a doctoral degree. Flipping through a Yale course catalogue, he thought, “Sociology—that sounds good.”
By 1994, he was an all-but-dissertation student with three children, and he'd just said yes to a full-time job. He would be the first director of the new homeless outreach team at Connecticut Mental Health Center.
The team’s challenge: connect homeless people, many of whom struggled with mental illness, to clinical care.
The Work of Homeless Outreach
Rowe had a preconceived idea about his new job. The Yale sociology department at the time, he said, was “big on organizational theory.” He anticipated conflicts between different organizational systems. Specifically: he expected his outreach team, with its scrappy, improvisational style, to clash with the large, traditional, psychiatric treatment center of which it was a part.
But once he hit the streets with the outreach workers, leaving behind the walls and gates of buildings and institutions, he began to see things differently.
“I thought, this is what’s happening,” he said. “This is where it’s going down—out on the street. That’s the heart of it. And it continues to be the heart of it.”
He took detailed notes, immersing himself simultaneously in day-to-day work and field observation.
On one hand, he said, homeless outreach was “the most idealistic work I’d ever seen.” But there was a shadow side, too.
“Outreach workers carry into the field, to a certain degree, the power of the state to have someone committed,” Rowe explained, "though I don't recall a single time when that happened. Still, you’re on the [homeless] person’s turf, and you carry power into that turf.”
His observations were cutting edge at the time and remain relevant: note the re-emergence of state power threatening to force unsheltered people into treatment today, in places such as California, New York City, and Portland, Oregon.
“I won’t say these weren’t clinical encounters,” he explained of homeless outreach. “But as a sociologist, I started thinking that clinical care wasn’t my business. I thought, there’s something else going on here.”
Social Encounters
“These were social encounters,” he asserted, “and they were happening at the margins—the social, psychological, physical, economic margins of society.”
Rowe’s observations and experiences with the homeless outreach team became the subject of his dissertation (he graduated in 1996) and later, his first book: Crossing the Border: Encounters Between Homeless People and Outreach Workers (1999).
First and foremost a writer, Rowe found a home in academia by writing his own way. At first, he wasn’t sure he would fit in. But while in graduate school, heading to the School of Public Health for the easiest statistics course he could find, he noticed a used book for sale at the library: Kai Erikson’s Everything In Its Path: Destruction of Community in the Buffalo Creek Flood.
“I couldn’t believe someone could write this way and be a sociologist,” he recalled. “It just blew me away. I thought maybe there was a home for me in sociology after all.” He took a course with Erikson, who became his mentor and is now a professor emeritus at Yale. They’re friends to this day.
Soon after Crossing the Border was published, Larry Davidson, PhD, asked Rowe if he would join a new research group that Davidson was starting, the Yale Program for Recovery and Community Health (PRCH). Rowe became its co-director; he was appointed to the clinical faculty of the Yale Department of Psychiatry in 1997 and later, to the ladder track. He’s been at PRCH ever since that time, working with Davidson and a host of diverse colleagues—from social scientists like himself, to clinical researchers, peer support professionals, quantitative and qualitative research experts, and more—who continue to find and challenge the borders in their field.
The sociology of homeless outreach led Rowe to his second big idea: citizenship, now a leading framework in mental health.
Roots of Citizenship
In this video about the roots of citizenship, Rowe tells the story of Jim, whose decision to leave his new apartment and move back out on the street profoundly surprised Rowe and his outreach team.
“We thought, oh my god, we have totally failed,” Rowe recalled. Backing into the problem conceptually, he explained his cardinal rule of homeless outreach: “Don’t make promises you can’t keep and keep all the promises you make.”
“But we had made promises we couldn’t keep,” he reflected. “Everything about outreach suggested what lay ahead for people”—clinical care and housing, but also belonging and full membership in society, which the system of care couldn't promise.
“I began to wonder, what kind of identities are we offering to help people attain? My thinking about it took me a long way,” he recalled. Questions of identity ultimately led him to citizenship.
Citizenship focuses on supporting people with mental illnesses as they (re)integrate into their communities. The citizenship approach to mental health care prioritizes rights, social roles, responsibilities, resources, and relationships (the “Five R’s: of Citizenship) as cornerstones of mental health recovery and the foundations of every person’s social belonging.
“In a way,” he explained, “citizenship tried to keep the promise that outreach could never keep.”
From its New Haven roots, the citizenship model has grown and flourished. In 2012, Rowe won first-place honors in the Department of Psychiatry’s “Clinical Innovation in Psychiatry” award for his Citizenship Intervention, designed to help people with mental illnesses and criminal justice convictions integrate into their communities. Today, the International Recovery and Citizenship Collective includes partners from Scotland, Spain, Canada, Brazil, Hong Kong, and other countries around the globe. Closer to home, the Connecticut Department of Mental Health & Addiction Services recently sponsored a two-year, state-wide Recovering Citizenship Learning Collaborative for mental health agencies.
In his book Citizenship and Mental Health (2015), Rowe wrote in depth about the practice, theory, and research of the citizenship model spanning two decades.
But the experience closest to his heart—more important than homeless outreach, sociology, or the multilayered work of citizenship—is the experience he wrote about in The Book of Jesse: A Story of Youth, Illness, and Medicine (2002). In this elegiac work he tells the story of his son Jesse’s death in 1995 after a long illness and protracted medical treatments.
“I wrote the book as a form of witnessing, but also as a work of art,” he said. Speaking of the experience of losing Jesse, he said, “It’s certainly affected my way of looking at things, looking at life—my sympathies for people and the suffering of others. Not that it wasn’t there before. It’s just a little different, and maybe deeper now.”
Rowe has revised The Book of Jesse and hopes to publish a second edition. He’s working on other writing projects, too, and is happy to have more time to write now that he’s retiring. And, he said, with understated joy, “I have a grandson now. That’s very cool.”
Transitions
As he transitions to professor emeritus status, it’s been a strange combination of the practical and the personal: calls, emails, and meetings, working through administrative retirement tasks with the business office, saying and hearing emotional goodbyes.
“I’ve been very fortunate to work with so many creative and smart people,” he said, then added with a chuckle, “I won’t name names, because if I do, I’ll leave someone out.”
The feeling is mutual. His many colleagues—including this writer and dozens of others here at Yale, members of the New Haven community, and mental health professionals around the world—love and appreciate him as a mentor whose torch they hope to carry forward. Fortunately, he’s not going away entirely. He will be working as a consultant to colleagues in Norway, writing, staying in touch.
One final question: does he have any advice for us?
Where to Pledge Allegiance
Models come and go, he said. Over the years, he’s been inspired to see others take up the mantle of citizenship and make it their own.
“My advice is to take what we’ve been doing and build on it,” he said. “Question it. Push yourselves. Push your own thinking. If citizenship is working, take it as far as you can go with it. And improve it.”
Your ideas are important, he noted, so give yourself time for your own creativity. “But it’s also important to ask yourself, where is the silence here? What am I missing?”
“I don’t pledge allegiance to citizenship,” he added, and no one should. “Pledge allegiance to the truth,” he advised, “and to the work you’re trying to do to help people.”
And with that, fast approaching his new life, he prepared to Zoom off.
“It’s an adventure,” he said of retirement. “If I knew what was going to happen with it, it wouldn’t be an adventure.”