One of the most common criticisms of "housing first" initiatives (programs to provide housing for unhoused people unconditionally without gatekeeping) is that housing first "does not improve mental health."
Now, let's set aside for the moment that this criticism is irrelevant -- the purpose of housing is to provide shelter, not to "improve mental health" -- what definition of "mental health" could possibly make this true? As much as I try to critique and deconstruct the social construction of "mental health," how could it possibly be true that having a safe, assured place to live would not result in greater happiness, greater inner peace, less depression, less anxiety, less negative emotions, than living on the street?
What possible definition of "mental health" would not be improved by being housed rather than unhoused?
Answering this requires unpacking the wildly different, almost completely unrelated, definitions of "mental health," one applied to relatively privileged people, and one applied to oppressed people.
For relatively privileged people, the concept of "mental health" is centered on emotional well-being, introspection and self-awareness, and the mitigation or management of negative emotions like pain, depression, anxiety, and anger.
For oppressed people, the concept of "mental health" is centered on compliance, obedience, and productivity.
Like most privilege disparities, this isn't binary. For most people who are privileged in some ways and marginalized in other ways, "mental health support" will include some degree of the emotional support given to privileged people, and some degree of the compliance and productivity training given to oppressed people, with the proportions varying on where exactly each person falls on various privilege axes. All children are oppressed by ageism, so all children's "mental health" has some elements promoting compliance, obedience, and productivity. But relatively privileged children may also receive some emotional support mixed in, while children of color, children in poverty, and children with existing neurodivergence labels will receive a much higher ratio of compliance training to emotional support.
One of the clearest illustrations of this disparity is the contrast between the "self-care" recommended to privileged people, and the "meaningful days" imposed on oppressed people.
Relatively privileged people are often told, by therapists, doctors, mental health culture, and self-help books, that they are working too hard and need to rest more. They're told that for the sake of their mental health, they need work-life balance, self-care, walks in the woods, baths with scented candles. Implicit in these recommendations is that the reason these people are working too hard is because of internal factors, like guilt or emotional drive, rather than external factors, like needing to pay the bills and not being able to afford a day off.
By contrast, unhoused people, institutionalized people, people labeled with "severe" or "serious" or "low-functioning" mental disabilities, are literally prescribed labor. Publicly funded "mental health initiatives" require the most marginalized members of society to work tedious jobs for little or no pay, under the premise that loading boxes at a warehouse will make their days "meaningful" and thus improve their "mental health." And unlike the self-care advice given to relatively privileged people, the forced-labor-for-your-own-good approach is not optional. People are either forced into it directly by guardians or institutions, or coerced into it as a precondition to access material needs like housing and food.
The form of "mental health" applied to relatively privileged people has some genuinely useful and beneficial elements. We could all stand to introspect and examine our own feelings more, manage our negative emotions without being overwhelmed by them, have self-confidence. We all need rest and self-care.
Still, privileged mental health culture, even at its best, is deeply flawed. At best, it tends to encourage a degree of self-centeredness and condescension. It's obsessed with classifying experiences as "trauma" or "toxic." It's one of the worst culprits in feeding the "long adolescence" phenomenon and generally perpetuating the idea that treating people as incompetent is doing them a kindness. Even the best therapists serving the most privileged clients have a strong tendency towards gaslighting and "correcting" people about their own feelings and desires.
But perhaps the worst consequence of privileged mental health culture is that it gives cover to the dehumanizing, abusive, compliance-oriented "mental health care" forced upon the most marginalized people. Privileged people are encouraged to universalize their experiences with sentiments like "We all deal with mental health" or assume that the mild, relatively benign "mental health care" they experienced are the norm, so what are those silly mad liberation people complaining about?
Tonight, I listened to a leader from an agency serving unhoused people talk about how "Everyone struggled with mental health during the pandemic"... and then later mention that their shelter categorically excludes people with paranoid schizophrenia diagnoses.
So perhaps "everyone struggles with mental health," but only certain people are categorically excluded from services, from shelter, from autonomy, from basic human rights, because of how their brains happen to work.
As always, it seems like so much effort in the mad liberation/ neurodiversity/ antipsychiatry movement is spent holding the hands of relatively privileged people receiving relatively privileged "mental health care" and reassuring them that we're not trying to take it away from them. Fine, it's great that you like your antidepressants and anti-anxiety medication and your nice therapist who listens to you and your support group. Great. Go live your best life. But that has nothing to do with our fight against forced drugging, forced labor, forced institutionalization, forced poverty. It's not even close to the same "mental health."
