The Modern Day Asylum: A Mad Studies Informed Approach to Understanding De- Institutionalization, Madness and Chronic Homelessness

Abstract

Background: The impetus behind the deinstitutionalization movement that began in the 1950s was to improve the wellbeing of institutionalized people as well as improve choice and access to inclusive community-based care. However, as large-scale institutions were closed, community- based alternatives were not added to meet the demand. This research looks at the experience of chronic emergency shelter users as an example of the ongoing systemic spatial segregation of people which was previously experienced in asylums. Drawing from some of the key features of Mad Studies, we utilize the experiences of chronic shelter users to posit enhanced approaches and supports to community-based interventions beyond the model of spatial segregation, which we argue is currently employed through direct and indirect measures. Approach: We conducted a cross-sectional study utilizing 300 survey interviews with chronically homeless people in Calgary, Alberta, Canada. Data was primarily quantitative but space for some qualitative answers were included. Analysis includes descriptive statistics, correlations, and regressions. Results: Participants reported high rates of trauma and system cycling, which were often inter- generational and starting in childhood. Troubling rates of self-identified “mental illness,” and mental health crises including suicide attempts and self-harm, and very limited success in accessing supports emerged. Results show that shelters and current housing models frequently replicate the segregation, confinements, control and surveillance of the asylums of the past which fail to meet individual needs and desires. Conclusion: Chronic homelessness and subsequent shelter use is the present reality of deinstitutionalization for many. Current attempts to fill gaps in the system of care replicate institutional care in various formats, and have halted progress towards the actualization of deinstitutionalization. Alternative responses require us to challenge the medicalization of homelessness as “mental illness.” Interventions including housing programs must be focused on healing from trauma and include the voices and experiences of lived experts.