Objective -- Mental health recovery is possible for many individuals, but those with cooccurring disorders and homelessness face additional challenges. Though a non-linear course is assumed, few studies have analyzed recovery over time. This mixed methods study examined recovery trajectories of 38 participants with DSM Axis I diagnoses over 18 months after enrolling in supportive housing programs.Methods -- Qualitative interview data were quantified through consensual ratings to generate a

more »

... ery score for four waves of data collection based upon eight recovery domains culled from the literature. Case study analyses were conducted of participants whose scores varied by onestandard deviation or more between baseline and 18 months to identify which domains were important.Results -- The majority (n=23) had no significant change in recovery, with eight having a positive and seven a negative trajectory. Case studies of these 15 participants showed domains that contributed to change (and numbers affected) were: significant other relationships (n=9), meaningful activities (n=9), mental health (n=7), family relationships (n=6), physical health (n=5), housing satisfaction (n=5), employment (n=2) and substance use (n=1). Except for mental health and substance use (only negative), domains were positive and negative in influence. Domains were intertwined in individuals' lives, e.g., variation in social relationships was linked to changes in meaningful activities.Conclusions -- This report showed little change in recovery over time for most and a decline in mental health for a small minority. Importantly, it underscores the importance of social relationships and meaningful activities among individuals with serious mental illness who experience complex challenges.