Medication adherence among people experiencing homelessness and mental illness: Navigating the precarity of street life

The adherence to prescribed psychiatric medication among people experiencing homelessness and mental illness (PEH-MI) is a major challenge. The instability, insecurity, and resource scarcity are inherent in street-based living. This study explored the lived experiences, coping strategies, and systemic barriers that impact medication adherence among this vulnerable population in the decade-long (2015–25) Pathways out of Homelessness. Through a qualitative approach involving semi-structured interviews with seven PEH-MI, the study explored how the participants navigate the reality of street life and personal resilience influence adherence behaviour. This study explored medication adherence through the lenses of street medicine theory. Findings reveal a complex interplay between self-determination and structural limitations, with participants employing creative and resourceful means such as informal peer networks, drop-in centres, and strategic routines to manage their mental health. The study highlights the urgent need for integrated, low-barrier support systems that address both housing and mental healthcare needs concurrently.