Sons, Daughters, and Sidewalk Psychotics
Mental Illness and Homelessness in Los Angeles
-
- $19.99
-
- $19.99
Publisher Description
Sociologist Neil Gong explains why mental health treatment in Los Angeles rarely succeeds, for the rich, the poor, and everyone in between.
Drawing on the nuanced experiences of patients and care providers, Sons, Daughters, and Sidewalk Psychotics introduces readers to two drastically different forms of community psychiatric services: public safety net clinics focused on keeping people housed and out of jail and elite private care trying to push clients toward respectable futures.
In downtown Los Angeles, many people in psychiatric crisis only receive help after experiencing homelessness or arrest. Public providers engage in guerrilla social work to secure housing and safety, but these programs are rarely able to deliver true rehabilitation for psychological distress and addiction. Patients are free to refuse treatment or use illegal drugs—so long as they do so away from public view. Across town in West LA or Malibu, wealthy people diagnosed with serious mental illness attend luxurious treatment centers. Programs may offer yoga and organic meals alongside personalized therapeutic treatments, but patients can feel trapped, as their families pay exorbitantly to surveil and “fix” them. Meanwhile, middle-class families—stymied by private insurers, unable to afford elite providers, and yet not poor enough to qualify for social services—struggle to find care at all.
Examining this divergent treatment of people facing similar mental struggles, Gong raises provocative questions about urban policy, individual freedom, and what it would take to create a fundamentally different psychiatric system—one that will meet the needs of patients, their loved ones, and society at large.
PUBLISHERS WEEKLY
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.
