Between care and control: A discourse analysis of Vancouver's "mental health crisis"

In 2013 the municipal government of Vancouver, British Columbia, Canada declared itself to be in the midst of a "mental health crisis", evident in increasing rates of psychiatric hospitalizations and violent incidents involving people with "untreated severe addictions and mental illness" (SAMI). This discourse analysis engages with policy texts published between 2008 and 2016 that problematize the "mental health crisis" and propose a range of solutions aimed at resolving it. Attention is given to the ways in which psy and security discourses reinforce the notion that people who struggle with mental health and substance use are sick, incompetent, and prone to irrational outbursts of violence. I argue that this characterization opens the door for a range of new technologies of governance in the inner city. Particular focus is given to proposals that Assertive Community Treatment (ACT) teams be implemented in partnership with the local police department to manage the risks that people with untreated "SAMI" were said to present for the security of the city. ACT typically involves a range of interdisciplinary mental health professionals who collaborate to deliver outpatient care to people with mental illness living in the community. However, in the Vancouver context, several teams have been modified to include roles for police officers in clinical service provision. There remains a scarcity of research on the forms of governmentality present in mental health program modifications that involve law enforcement. This dissertation uses Carol Bacchi's (2009a) What's the Problem Represented to be? (WPR) approach to interrogate the problem representations found in mental health policy documents that position ACT as key to ameliorating Vancouver's "crisis". The WPR approach starts with the basic premise that policies make a variety of assumptions in the way they understand the problems they seek to address. Instead of studying "problems", it examines the problematizations surrounding the "crisis", and the discursive, subjectification, and material effects they produce. I also elucidate how forms of resistance advanced by activists, critical scholars, and people with lived experience of mental distress and substance use challenge the coercive practices of new regimes of community-based care.