title: "Talk with me": perspectives on services for men with problem gambling and housing instability.
abstract: Problem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario.
  
  
  
  We used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men's perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services).
  
  
  
  The concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men's experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support.
  
  
  
  Our study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery.
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. sara.guilcher@utoronto.ca.|Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. sara.guilcher@utoronto.ca.|Institute for Clinical Evaluative Sciences, 155 College Street, Suite 424, Toronto, M5T 3M6, Canada. sara.guilcher@utoronto.ca.
authors.forename: Sara J T
authors.initials: SJ
authors.lastname: Guilcher
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hamilton-Wright
authors.affiliation: Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
authors.forename: Wayne
authors.initials: W
authors.lastname: Skinner
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Woodhall-Melnik
authors.affiliation: Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Ferentzy
authors.affiliation: Good Shepherd Ministries, 412 Queen Street East, Toronto, ON, M5A1T3, Canada.
authors.forename: Aklilu
authors.initials: A
authors.lastname: Wendaferew
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.|Institute for Clinical Evaluative Sciences, 155 College Street, Suite 424, Toronto, M5T 3M6, Canada.|Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
authors.forename: Flora I
authors.initials: FI
authors.lastname: Matheson
mesh_terms: D000368:Aged; D003142:Communication; D055812:Community-Based Participatory Research; D004645:Empathy; D005715:Gambling; D006703:Ill-Housed Persons / Q000523:psychology; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D036301:Qualitative Research; D012940:Social Problems; D012947:Social Work
keywords: Complex needs; Homeless; Housing instability; Men; Problem gambling; Services