Chronic, Disruptive, or Resistant? Target Ecologies and the Medicalization of Homelessness in California

Abstract

Abstract How do place and social context shape how policymakers construct the targets of state interventions? This paper analyzes recent proposals in California to subject people experiencing homelessness to involuntary psychiatric treatment. Using newspaper articles, legislative hearings, government reports, and interviews, we show how policymakers frame “the homeless mentally ill” in distinctive ways: Chronic and contained people who require extended institutionalization, disruptive and visible individuals who need a period of forced sobriety, and a service-resisting and underserved population whom mental health agencies have overlooked, but who could comply with treatment with a coercive incentive. We argue these constructions reflect how policymakers represent specific target ecologies: concentrated but confined homelessness on LA’s Skid Row, frequent and expensive use of emergency services in San Francisco’s Tenderloin, and expanding homelessness in jurisdictions traditionally reticent to provide care, as in San Diego County. This paper shows the value of disaggregating broad population categories to show how they are differentially problematized, as policymakers seek to gain support and justify intervention in specific places. We also illustrate a broader policy trend of reframing involuntary treatment as a progressive and compassionate response to substance use, homelessness, and urban disorder.