Sons, Daughters, and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles

In this nuanced study, UC San Diego sociologist Gong (co-editor of Beyond the Case) compares and contrasts two mental health “treatment approaches” in Los Angeles. The city’s underresourced Department of Mental Health, which serves the homeless population, concentrates on procuring stable housing in the hope that taking clients off the streets will curtail their self-destructive behavior. Meanwhile, the Actualization Clinic, an elite private treatment center, directly addresses clients’ psychiatric needs, working with them to rebuild their identity. Both organizations are to some extent hamstrung by a client’s legal right to reject medications, counseling, and housing options, but Gong shows that only the Actualization Clinic and other private sector operations can really face down this obstacle. Patients in the resource-poor public sector, once housed, are left to do as they please, whereas the private sector leverages the client’s financial resources to implement systems of therapeutic micromanagement and surveillance that maintain the behavior necessary for effective treatment. Cogently observing that psychiatric patients’ need for housing and therapeutic surveillance were both “problems once ‘solved’ by the asylum,” Gong persuasively recommends establishing a more structured outpatient system of public mental health care (while cautioning against a return to the asylum’s prison-like potential for abuse). Mental health professionals and advocates will find much to learn. (Mar.)