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Supportive Housing and Surveillance

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Abstract

Urban centres in the US, Britain and Canada have responded to identified visible ‘social problems’ such addiction, mental health and homelessness by providing some supportive housing for the urban poor and marginalized. While some critics have questioned what supportive housing specifically entails in terms of the built environment, what remains under explored, though a growing area of concern, is the relationship between surveillance and supportive housing for urban residents identified as having addiction and mental health problems — a gap addressed in this paper. Drawing upon qualitative ethnographic observational data we examine some of the measures of control and coercion that are encroaching into social housing primarily established for poor and marginalized people with addiction and mental health problems in the urban centre of Vancouver, Canada. We witnessed three modes of regulation and control, that vary widely, among the residencies observed: physical surveillance technologies; site-specific modes of coercion; police presence and staff surveillance, which all together impact the everyday lives of residents living in low-income and supportive housing. We argue that supportive housing has the potential to provide its intended commitment— safe and secure affordable housing. However, owing to an (over)emphasis on ‘security’, the supportive housing we observed were also sites of social control.

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... Half of the studies focused on people with mental health problems living in independent apartments and the other half in congregate settings. One study (Boyd et al., 2016) did not mention the number of participants, and two studies (Marcheschi et al., 2013(Marcheschi et al., , 2015 drew on the same empirical data. In summary, the studies included about 2086 people with mental health problems as participants. ...
... In congregate settings (Baltazar et al., 2013;Boyd et al., 2016), tenants disliked high regulation by staff of everyday activities, such as day plans or scheduled medication. Piat et al. (2017) studied tenants in supported housing living independently who had recently moved from custodial housing types. ...
... The asymmetric relations were illustrated by symbols of power and surveillance, such as 'glass-paned office rooms where staff could easily observe residents and guests' (Boyd et al., 2016, p. 75). Boyd et al. (2016) gave examples of inequality and criminalisation of these living places, such as non-tenants discrediting these places as custodial, tenants' confidential health care information being shared and police often being present inside and outside these places (an 'open-door policy'). ...
Article
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Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.
... Despite the widespread use of SROs by PLWH, there is a dearth of research on the association between living in SROs and HIV-related health outcomes and behavior [19]. Indeed, most of the insights on SROs and health are based on studies examining residents with substance use and/or mental health disorders [20][21][22]. These few SRO-focused studies suggest that overall these abodes afford substandard living conditions, limited safety and stability and increase residents' sex and drug risk behaviors. ...
... We found only a couple of studies on marginally housed impoverished women and persons who use drugs [20][21][22] that discuss the presence of violence in subsidized housing, including SROs. Boyd and colleagues [20] noted that in Vancouver, subsidized housing residents with substance use and mental health disorders were subjected to different forms of surveillance and social control that seemed antithetical to harm reduction and current public health practice. ...
... We found only a couple of studies on marginally housed impoverished women and persons who use drugs [20][21][22] that discuss the presence of violence in subsidized housing, including SROs. Boyd and colleagues [20] noted that in Vancouver, subsidized housing residents with substance use and mental health disorders were subjected to different forms of surveillance and social control that seemed antithetical to harm reduction and current public health practice. Our analysis extends this discussion by explaining how the endemic physical and symbolic violence in SROs deprived residents of autonomy, self-worth and self-efficacy, and contributed to a habitus antithetical to focusing on and proactively caring for one's health, including engaging in outpatient care. ...
Article
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Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents’ health and wellbeing.
... In particular, this study shows how policies and practices specific to low-income housing frame the experience of home and the sense of security necessary to feel 'at home' by limiting participants' ability to exert control over their personal space. While this experience may be common to PWUD living in low-income housing in general (Boyd, Cunningham, Anderson, & Kerr, 2016;Fast, 2017;Fast & Cunningham, 2018), the impact of such a loss of autonomy is of particular importance for PLHIV who use drugs, as it can shape HIV care and treatment outcomes. The normalization of the high level of surveillance and regulation in low-income housing environments undermines the right to privacy that other, non-marginalised members of society consider integral to their experience of home (Boyd et al., 2016). ...
... While this experience may be common to PWUD living in low-income housing in general (Boyd, Cunningham, Anderson, & Kerr, 2016;Fast, 2017;Fast & Cunningham, 2018), the impact of such a loss of autonomy is of particular importance for PLHIV who use drugs, as it can shape HIV care and treatment outcomes. The normalization of the high level of surveillance and regulation in low-income housing environments undermines the right to privacy that other, non-marginalised members of society consider integral to their experience of home (Boyd et al., 2016). This contrasts starkly with previous research that understands home as a space of freedom and control in which one is able to set and maintain unique personal boundaries (Mallet, 2004). ...
... Consistent with previous research illustrating the perceived benefits to security of particular building policies and surveillance mechanisms (Krüsi et al., 2012), our participants invited these perceived improvements to their security despite the impact it may have on their ability to exert control in housing. Although, an alternative view may understand this as an indicator of the degree to which such forms of control and surveillance are normalised amongst drug-using populations (Boyd et al., 2016). Future research should consider the specific mechanisms through which security and surveillance differentially impact experiences of home. ...
Article
Introduction Housing is a critical determinant of HIV-related outcomes among people living with HIV (PLHIV) who use drugs, including on HIV treatment adherence. Research shows that sense of home may have important implications for mitigating harms associated with low-income housing environments among PLHIV who use drugs, but how this shapes treatment is poorly understood. Methods Semi-structured interviews were conducted with 31 PLHIV who use drugs recruited from an ongoing prospective cohort in Vancouver, Canada. Recruitment was targeted towards individuals living in single room occupancy housing who had previously reported low treatment adherence. Interviews were co-led with a peer research assistant, and focused on housing conditions, drug use patterns, and HIV management. Interviews were transcribed, analyzed thematically, and interpreted by drawing on concepts of home and place-making. Results The ability to exert control over housing environments contributed to participants’ perceptions of home by fostering feelings of safety and allowing for creation of personalized space. Participants readily identified the importance of housing stability and quality in maintaining health (e.g. food storage, pest-free), including HIV care. However, informed by social-structural mechanisms that undermined agency, negative experiences of home adversely impacted treatment adherence. Conclusions Findings indicate that sense of home may enable ability to manage HIV care, and is promoted through feelings of security within, and control over, housing environments. Supports in navigating competitive housing markets are needed to address the role that home plays in HIV treatment adherence.
... However, she emphasizes that specific modalities can lead to non-caring protection (i.e., police interventions or paternalistic measures). Boyd et al. (2016) argue that care in supportive housing is often concomitant with invasive practices, such as regular verifications of apartments' ...
... conditions or checking visitors' identities. Tenants, especially women, have various perceptions of such measures: for some, it improves safety, but for others, it restricts residents' freedom and privacy, making them feel infantilized or like prisoners, and thus, not at home (Boyd et al., 2016;Thompson, 2018). ...
Article
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The lack of affordable housing in Canada affects a growing number of female heads of single-parent families, and the current political economy presents significant obstacles to develop more social housing in response. This paper seeks to understand the extent to which new housing programmes led by community providers comply with or resist neoliberalisation. We draw on feminist ethics of care to explore and deepen the ideas, interests, institutions, and networks involved in creating social housing for female heads of single-parent families in Montreal, Toronto, and Vancouver, Canada. The cases reveal that neoliberalisation is not eliminating care in the social housing sector. On the one hand, communities that embrace and engage with the principles of care comply with state rollback by stepping up to meet pressing needs despite the inadequacies or unavailability of public programmes. On the other hand, care ethics lead them to design programmes and spaces centred on family needs, which resist the climate that hampers social housing development and orients it toward market-driven solutions and neoliberal expectations. We conclude with a critical reflection on the inequalities in communities’ capacity to create housing with care to meet the identified needs and thereby resist the neoliberalisation of social housing.
... While research has illustrated how particular forms of low-income housing regulate marginalized populations (Boyd et al., 2016), less attention has been paid to their role in reinforcing 'everyday' (Scheper-Hughes, 1996) and symbolic (Bourdieu, 2001;Epele, 2002) forms of social violence prevalent in drug scenes. Everyday violence draws attention to forms of violence (e.g. ...
... Examining these technologies implemented within SRAs as mechanisms used to exert power over and govern (Foucault, 1977) in this case, WWUDis important as such mechanisms regulate bodies and space. However, surveillance mechanisms are not applied equally, with marginalized individuals less able to protect themselves from surveillance structures (Boyd et al., 2016;Gillion, 2001;Glasbeek and van der Meulen, 2014). As such, WWUD are particularly impacted by surveillance in complex ways given the extensive histories of the observation and policing of femininity by men (Glasbeek and van der Meulen, 2014). ...
... Although this research is based on a single-site facility, the PSH management policies explored are commonly employed in PSH residences provincially and even internationally (Boyd et al., 2016;Collins et al., 2018;Kr€ usi et al., 2012;Parsell, 2016;Parsell et al., 2015). Given the ubiquity of basic psychological needs as defined by SDT, we anticipate that themes identified in this analysis are relevant to many PSH facilities in North America, regardless of the HIV status of their tenants. ...
... The housing provider's use of policies enhanced perceived safety and autonomy for some participants, while inadvertently interfering with other participants' efforts to meet alternative housing needs. Previous research corroborates our findings that surveillance in social housing enhances security but decreases privacy, thereby both supporting and undermining autonomy and selfdetermination (Boyd et al., 2016;Collins et al., 2018;Kr€ usi et al., 2012;Parsell, 2016). In terms of SDT, surveillance is a source of extrinsic motivation to behave in socially desirable ways, which results in controlled behaviours, thereby undermining selfdetermination and stunting self-regulating behaviours (Deci & Ryan, 2016). ...
Article
Permanent Supportive Housing (PSH) increases housing stability and improves health outcomes among people living with HIV (PLHIV) at risk of homelessness. We conducted 24 semi-structured qualitative interviews with PLHIV at risk of homelessness living in a PSH building in Vancouver, Canada, with the aim of understanding how PSH building policies impact residents’ health. Interviews were analyzed using self-determination theory and Housing First principles. The housing provider prioritized residents’ physical safety, while participants often prioritized other needs, such as autonomy and relatedness. While building policies improved some participants’ perceived safety or autonomy, these policies simultaneously interfered with other participants’ efforts to meet alternative needs. In contrast, supportive strategies, such as the autonomy-supportive models of Housing First initiatives, appear more effective at meeting needs, with fewer unintended consequences. A shift towards autonomy-supportive housing environments for persons with complex psychosocial needs at risk of homelessness is needed, as is the deliberate alignment of resident population, tenant intake, building structure, and program model.
... The patients at Poppy also had access to social and legal support, housing, and therapy. In the documentary, housing in Denmark is depicted as consisting of one-bedroom apartments rather than single-room occupancy (SROs) or small studio apartments so favored for the poor by all levels of government in Canada [27]. ...
Article
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Background This article highlights the experiences of a peer-run group, SALOME/NAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique independent peer- run drug user group that formed in 2011 following Canada’s first heroin-assisted treatment trial (HAT), North America Opiate Medication Initiative (NAOMI). SNAP’s members are now made up of former research participants who participated in two heroin-assisted trials in Vancouver. This article highlights SNAP members’ experiences as research subjects in Canada’s second clinical trial conducted in Vancouver, Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), that began recruitment of research participants in 2011. Methods This paper draws on one brainstorming session, three focus groups, and field notes, with the SALOME/NAOMI Association of Patients (SNAP) in late 2013 about their experiences as research subjects in Canada’s second clinical trial, SALOME in the DTES of Vancouver, and fieldwork from a 6-year period (March 2011 to February 2017) with SNAP members. SNAP’s research draws on research principles developed by drug user groups and critical methodological frameworks on community-based research for social justice. Results The results illuminate how participating in the SALOME clinical trial impacted the lives of SNAP members. In addition, the findings reveal how SNAP member’s advocacy for HAT impacts the group in positive ways. Seven major themes emerged from the analysis of the brainstorming and focus groups: life prior to SALOME, the clinic setting and routine, stability, 6-month transition, support, exiting the trial and ethics, and collective action, including their participation in a constitutional challenge in the Supreme Court of BC to continue receiving HAT once the SALOME trial ended. Conclusions HAT benefits SNAP members. They argue that permanent HAT programs should be established in Canada because they are an effective harm reduction initiative, one that also reduces opioid overdose deaths.
... Though in a clinical setting for the trial, PSUD remain in danger of criminalization given the illegality of substance use, and at heightened risk of being targeted by police when in settings associated with social and economic deprivation. In these settings, PSUD can become more visible and suspect to police, for instance, by living in social housing (Boyd, Cunningham, Anderson, & Kerr, 2016) or spending time in Vancouver's Downtown Eastside 1 neighborhood (Wittmer & Parizeau, 2016). Here, as in similar jurisdictions, concentrated resource scarcity, strong community bonds, and social housing are linked to an active drug scene (Ivsins, Vancouver Area Network of Drug Users, Benoit, Kobayashi, & Boyd, 2019;Liu & Blomley, 2013;Shannon, Ishida, Lai, & Tyndall, 2006). ...
Article
Amid the growth of addiction medicine randomized controlled trials (RCTs), scholars have begun examining participants’ study experiences, highlighting facilitators and barriers to enrollment. However, this work can overlook the interplay between trial participation and social-structural dimensions among people with substance use disorders linked to the social nature of use, socioeconomic marginalization, and time demands of substance procurement and use. To effectively conduct RCTs with this unique population, it is necessary to examine the broader social context of study participation. We conducted nested qualitative interviews with 22 participants involved in an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Thematic analyses revealed social-structural circumstances shaping RCT participation as well as how participation constitutes a turning point, prompting individuals to reconfigure social networks, reorient to spatial environments, and reorganize day-to-day life—with implications for how substance use disorder RCTs should be approached by researchers.
... Vancouver, Canada's Downtown Eastside (DTES) neighbourhood is the site of complex social-structural tensions inherent to neoliberal policies, with entrenched poverty and drug use occurring in the context of rapid gentrification and economic restructuring. Social-structural inequality stemming from neoliberal urbanism, including federal disinvestment in low-income housing, increased contract and temporary work, insufficient and stagnant levels of income assistance and the emergence of new forms of carceral control (e.g., surveillance expansion, targeted policing), shape the everyday lives of PWUD in this neighbourhood (Boyd, Cunningham, Anderson, & Kerr, 2016;Krebs et al., 2016). Over the past several decades, these forms of structural violence have driven epidemics of gendered violence (Bungay et al., 2010;Culhane, 2003;Jiwani & Young, 2006;Oppal, 2012;Shannon, Rusch et al., 2008), fatal and non-fatal overdose and infectious disease outbreaks (HIV, Hepatitis C) (BC Coroners Service, 2017; Wood et al., 2007), while disproportionately impacting women, gender minorities, and Indigenous peoples (Amnesty International, 2009; Inter-American Commission of Human Rights, 2014; Lyons et al., 2016). ...
Article
Background: Income is an important determinant of health among people who use drugs (PWUD). However, understanding transitions between differing types of income generation within the formal and informal economy and how they can be shaped by vulnerability to risk and harm remain poorly understood. This study examines how transitions in income-generating activities are shaped by and influence exposure to violence among marginalised PWUD, in Vancouver, Canada's, Downtown Eastside (DTES) neighbourhood. Methods: Qualitative interviews were conducted with twenty-six individuals engaged in informal and illegal income-generating activities in the DTES. Interview transcripts were analyzed thematically, focusing on relationships between income generation and violence during the study period between January 2014 to April 2015 and drew upon concepts of social violence when interpreting these themes. Results: Participants' engagement in informal and illegal income-generating activities represented a means to negotiate survival given multiple barriers to formal employment and inadequate economic supports. Our findings highlight how informal and illegal income-generating activities in the DTES are characterized by structural, symbolic and everyday violence, while transitions from 'high risk' (e.g., sex work, drug dealing) to perceived 'low risk' (e.g., recycling) activities represent attempts to reduce exposure to violence. However, participants emphasized how informal income generation was nonetheless shaped by structural violence (e.g., gendered hierarchies and police harassment), experienced as everyday violence, and introduced exposure to alternate risks. Conclusion: Our findings underscore the critical role of income generation in shaping exposure to violence, highlighting the need for low-threshold employment interventions targeting PWUD as a central component of harm reduction strategies.
... Regardless of whether one lives in congregate or independent housing, the built environment and the quality of the neighbourhood both matter (Friesinger et al. 2019a). On the one hand, congregate settings may architecturally resemble care homes with their added focus on surveillance technologies (Boyd et al. 2016) or fire safety (Friesinger et al. 2019b), both of which can exaggerate the otherness of tenants, while independent settings could be viewed as more or less ordinary private homes. On the other hand, both housing types could be located in either run-down areas or areas with meaningful places nearby, like amenities, parks, and churches or other spiritual places, which might in turn improve the social identity and wellbeing of their tenants. ...
Article
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Our daily lives and sense of self are partly formed by material surroundings that are often taken for granted. This materiality is also important for people with mental health problems living in supported housing with surroundings consisting of different healthcare services, neighbourhoods, buildings or furniture. In this study, we explored how understandings of tenants are expressed in the materialities of supported housing. We conducted ethnographic fieldwork in seven different supported accommodations in Norway and analysed the resultant field notes, interviews, photographs and documents using Situational Analysis. The analysis showed that supported housing materialities expressed a blurry picture comprising widening and narrowing understandings of tenants, both by others and by themselves. Widening understandings concerned how tenants were living their lives in their own ways in private rooms while maintaining a social life in common areas. Narrowing understandings pertained to understand the tenants based solely on their diagnosis and need for care and control in hospital-like buildings. The following discussion focusses on the ideas that underlie narrowing materialities and on the importance of striving for atmospheres that entail a sense of belonging.
... Our participants described similar experiences when navigating public spaces and other highbarrier shelter spaces. Further, similar to research on surveillance and social control of PWUD through public health interventions (Boyd et al., 2016;Fischer et al., 2004;Szott, 2014), our study demonstrates that even the most well-intentioned harm reduction interventions can have their limitations, particularly given the structural vulnerabilities of homeless PWUD in the context of other overarching social, structural, and physical environments that foster social control and internalized surveillance. This begs the question of how to provide supportive spaces for drug use while also effectively addressing overdose risk given the internalization of drug-using norms and expectations. ...
... This same lack of surveillance was preferred by some participants as it allowed them to purchase drugs in HOPS. As increased surveillance in SRAs can enable forms of control (Boyd, Cunningham, Anderson & Kerr, 2016), it is important to communicate with residents to determine what changes should be made to increase feeling safe in HOPS. Further, there is a critical need to increase HOPS resources to improve staff and peer worker overdose response training and hire additional staff to monitor HOPS as this may contribute to accessibility of HOPS, thereby minimizing fatal overdose risk. ...
Article
Background: In response to a fentanyl-driven overdose crisis, low-threshold supervised consumption sites, termed overdose prevention sites (OPS), have been rapidly implemented in Vancouver, Canada. Since approximately 88% of fatal overdoses in the province occur indoors, OPS have been integrated into select non-profit-operated single room accommodations (SRA) housing. We examined the social-structural features of these housing-based OPS (HOPS) on women's overdose risk. Methods: Ethnographic research was conducted from May 2017 to December 2018 in Vancouver. Data included 35 in-depth interviews with women who use drugs living in SRAs and approximately 100 h of observational fieldwork in SRAs and surrounding areas. Data were analyzed using an intersectional risk environment approach, with attention to equity and violence. Findings: Findings demonstrate that the social and structural environments of HOPS created barriers for women to access these interventions, resulting in an increased overdose risk. Primary barriers included uncertainty as to who else was accessing HOPS, rules prohibiting smoking, and a lack of trust in staff's abilities to effectively respond to an overdose. Most participants considered HOPS to be unsafe environments, and expressed fear of violence from residents and/or guests. The perceived risk of violence was informed by previous experiences of assault and the witnessing of violence. Many participants thus consumed drugs alone in their rooms to better control their safety, despite heightened overdose risk. Further, most participants did not perceive themselves to be at risk of an overdose due to drug use practices and tolerance levels, and viewed using alone as a safer option than HOPS. Conclusion: Findings highlight how the low-barrier design and operation of HOPS can undermine women's engagement with HOPS. Overdose prevention strategies in SRAs should also include gender-specific models (e.g. women-only HOPS, women peer workers) to help mitigate barriers to these services within the context of the current overdose crisis.
... Whereas PWUD in private housing experienced housing vulnerability in spite of the protections supposedly granted to them by the Residential Tenancy Act, those in non-profit buildings were rendered vulnerable to eviction due to the implied absence of legislated tenant protections. Consistent with previous research noting the heavy governmentality and surveillance PWUD face in their daily lives (Boyd, Cunningham, Anderson, & Kerr, 2016;Collins et al., 2018), our participants saw non-profit housing as heavily controlled and surveilled environments in which behaviour was dictated and housing providers could evict at any time for any reason. Therefore, these were spaces in which violations of building policies were easily caught. ...
Article
Background: People who use drugs (PWUD) commonly experience housing vulnerability due to the intersection of drug laws, housing policies, gentrification, and social marginalization. Housing vulnerability produces social suffering amongst PWUD and is linked to health and social harms. In Vancouver, Canada, the rapid gentrification of the Downtown Eastside - a low-income inner-city neighbourhood - and the lack of affordable housing has led to residential evictions emerging as a key community concern. This study sought to understand the policies and practices that produced evictions among PWUD, situating vulnerabilities to evictions within the context of wider structural vulnerability of PWUD. Methods: Between June 2015 and March 2016, baseline and 3-6 month follow-up qualitative interviews were conducted with recently evicted (past 60 days) PWUD in the Downtown Eastside. Participants were recruited by Peer Research Assistants. Baseline interviews (n = 56) focused on causes and socio-legal contexts of evictions, with follow-up interviews (n = 41) focusing on longer-term impacts. Interviews were analyzed thematically and interpreted by drawing on the concept of structural vulnerability. Results: Most participants were evicted unlawfully, unfairly, and into homelessness. Participants were rendered structurally vulnerable to unlawful evictions by the shortcomings of existing residential tenancy laws and current dispute mechanisms. Residents of non-profit buildings, for whom it was unclear if provincial residential protections apply, found their housing security further undermined through the denial of rights extended to privately-housed tenants. Attempts to assert tenant rights further increased participants' vulnerability to eviction through landlord retaliation and targeting. Conclusion: Findings demonstrate the inadequacy of existing housing policies and tenancy supports to account for the structural vulnerability of PWUD and their role in driving harms. Policy reforms are needed to address unlawful evictions and increase tenancy security, and must be accompanied by low-barrier interventions to more fully address this key driver of social suffering among PWUD.
... Our findings suggest that there are many structural vulnerabilities that particularly affect the day-to-day lives of PWUD in the DTES, including poverty and criminalization, and in turn shape willingness to use DCTs. Numerous studies have identified multiple environmental and contextual factors that increase these vulnerabilities and risks associated with drug use (Boyd, Cunningham, Anderson, & Kerr, 2016;Briggs et al., 2009;Ciccarone & Bourgois, 2016;Duff, Deering, Gibson, Tyndall, & Shannon, 2011;Fast, Shoveller, Shannon, & Kerr, 2010;Hembree et al., 2005;Hien, Giang, Binh, & Wolffers, 2000;Krusi, Fast, Small, Wood, & Kerr, 2010;Lazarus et al., 2011;McNeil, Cooper et al., 2015;Parkin, 2016;Philbin et al., 2008;Ramos et al., 2009;Rhodes et al., 2006Rhodes et al., , 2012Shannon et al., 2006;Small et al., 2007;Tempalski & McQuie, 2009). For example, poverty was highlighted by multiple participants as a factor that impacted participants' willingness to give up a drug sample. ...
Article
Background: Novel public health interventions are being considered to address the opioid overdose epidemic, including drug checking technologies. We examined the willingness to use various drug checking technologies among structurally-vulnerable people who use drugs (PWUD). Methods: We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD. Results: Overall willingness to use drug checking technologies was low among participants. A range of factors undermined potential use of various drug checking technologies including: having to give up a drug sample; time dedication; discrepancies regarding measurements and accuracy; recourse following positive fentanyl results; ambivalence to overdose risk; and availability and accessibility of drug checking technologies. Conclusions: Participants discussed numerous factors that undermined potential willingness to use drug checking technologies. These factors underscore the structural vulnerabilities experienced by PWUD and how they may constrain uptake of drug checking technologies. Future drug checking programming should consider these influencing factors prior to the implementation of drug checking technologies to ensure that drug checking interventions are appropriate and meeting the needs of target populations.
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Housing Associations operate at the community level between the state, market, and individual, and in the current political context of austerity, state roll-back, and welfare reform, have been increasingly tasked with focusing on the ‘welfare’ of their tenants. This has included ‘encouraging’ a trajectory of training for work for those tenants that are unemployed; a trajectory that is aimed at producing a certain type of ‘active’ and appropriate citizen-tenant at the local level, and which is based on the problematisation of those in social housing. This paper concentrates on how this trajectory is mobilised and implemented with an emphasis on how we conceptualise the dynamics and complexities of care and control that are central to this. HAs are framed as important locally-based institutions tasked with the local enactment of national policy imperatives. Through training-for-work initiatives, we explore how tenants are marked through the physical and conceptual spaces operated by HAs, and how HAs act as intermediaries between wider policy imperatives and localised, place-specific, and embodied interactions between tenants and housing professionals. We reflect on the dynamics of care and control involved in tenant engagement, with ‘care’ couched in terms of support and empathy but prompted by systems of control that classify and mark out tenants as in most ‘need’. We highlight the important role of HAs as fluid institutional sites of connection, emphasising the embodied and spatial regulatory relations through which careful control is enacted and practised.
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Since the early 2000s, tenants of seniors’ social housing in BC have increasingly shared their buildings with younger persons who have severe mental illnesses and/or addiction issues. While this demographic shift does not neatly correspond with a specific policy change, academics, media sources, and the experts and stakeholders interviewed for this report all have suggested that it results from the prioritization of the hard-to-house by the provincial government. For many seniors, this new environment has produced a host of negative outcomes: increased levels of fear; greater social isolation; more disruptive and unpredictable living conditions; and exposure to criminal activity, threats, violence, and other disturbing or dangerous behaviors. This paper examines the emergence of this policy problem and explores possible policy solutions. It does this through a literature review, six case studies from American jurisdictions, and thirteen interviews with experts and stakeholders. Ultimately, the paper recommends two interventions: funding and creating training materials for resident service coordinators, and an environmental scan of the approaches currently being made by the more than 550 non-profit housing organizations which provide nearly 90% of British Columbia’s social housing units.
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Vancouver's Downtown Eastside (DTES) neighbourhood is commonly associated with stigmatized and criminalized activities and attendant risks and harms. Many spaces/places in this urban neighbourhood are customarily portrayed and experienced as risky and harmful, and are implicated in experiences of structural (and physical) violence and marginalization. Drawing on 50 qualitative interviews, this paper explores how spaces/places frequently used by structurally vulnerable people who use drugs (PWUD) in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as enabling safety and wellbeing. Study participants recounted both negative and positive experiences with particular spaces/places, suggesting the possibility of making these locations less risky and safer. Our findings demonstrate how spaces/places used by PWUD in this particular geographical context can be understood as assemblages, a variety of human and nonhuman forces - such as material objects, actors, processes, affect, temporal elements, policies and practices - drawn together in unique ways that produce certain effects (risk/harm or safety/wellbeing). Conceptualizing these spaces/places as assemblages provides a means to better understand how experiences of harm, or conversely wellbeing, unfold, and sheds light on how risky spaces/places can be re-assembled as spaces/places that enable safety and wellbeing.
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Intimate partner violence (IPV) shelters are a critical resource for women experiencing IPV. Shelters can provide survivors a safe location separated from their partners to allow them to seek assistance and make choices about the future of their relationship. IPV shelters have been shown to be effective at giving women the sense of security they need as well as improving the health of women who chose to reside in shelter. Whereas the research on women’s experiences with services in IPV shelters has been extensively explored, little is known about the experiences of women living within the shelter structure and their interactions with the staff. This study utilised a social work-specific qualitative interpretative meta-synthesis approach to analyse nine published qualitative articles to gain a deeper understanding of women’s experiences living in IPV shelters. The findings of this study reveal two central themes: power and control, and safety and security. We discuss the results as valuable insights into service provision for women survivors of IPV living in IPV shelters.
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Prisoner reentry is widely recognized as a hybrid project of poverty governance situated at the intersection of the welfare state and penal state. Numerous scholars have examined the devolved terrain and organizational dynamics of reentry services. Still others have emphasized the particular challenges and importance of housing to the reentry process. However, few have examined how reentry organizations secure or manage housing for their clients, particularly in an era marked by a widespread housing affordability crisis and the retrenchment of public housing in favor of privatized subsidized housing provision. In this article, we present an ethnographic case study of one particularly illustrative site: “New Beginnings,” a new and novel housing development in Syracuse, NY, codeveloped and comanaged by a prisoner reentry organization and a local housing authority. We show that, despite its ostensible mission to integrate the formerly incarcerated and provide much-needed housing to the poor, the development reproduces the stigma of criminal history, producing a sense of ambivalence among residents, who are both grateful for the quality of their new housing and resentful of ongoing forms of carceral supervision and control. In turn, formerly incarcerated residents uphold their participation in the program as a way to distinguish themselves from traditional public housing tenants, further entrenching dominant narratives about the failures of public housing. These findings reveal the complex interplay between the project of reentry and the provision of subsidized housing in the post-public housing era.
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The purpose of this research is to explore the representation of participants of the canceled Basic Income Pilot in Ontario, Canada. Applying social actor representation analysis and the Discourse-Historical Approach of Critical Discourse Analysis, we examined news articles and government Hansard records about the canceled Ontario Basic Income Pilot in 2018. A number of myths about poverty emerged in our analysis (e.g., “people are lazy, unmotivated, and need incentives to work”; “poor people are mentally ill and drug addicted”). We challenge the veracity of these myths, showing how they perpetuate an individual explanation of poverty, and are deeply flawed.
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Background Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically ‘gender-neutral’, thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some women's access. Such dynamics highlight the significance of North America's first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores women's lived experiences of this unique harm reduction intervention. Methods Ethnographic research was conducted from May 2017 to June 2018 to explore women's experiences with SisterSpace in Vancouver's Downtown Eastside, an epicenter of Canada's overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. Findings The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as ‘deviant’ and ‘victims’, enabling knowledge-sharing of experiences through a gendered lens. Conclusion SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.
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In Australia, significant current reforms to Indigenous affairs emphasize the mutual responsibilities of government and citizens. Under these new arrangements, government is mainstreaming many programmes and services for Indigenous people, whilst demanding that they assume greater responsibility for their own welfare. For its part, housing welfare in remote Indigenous and town camp communities is being repositioned under the mainstream public housing model. This paper reports on qualitative research on the micro-scale of housing policy implementation to highlight the local operation of a responsibility agenda in these settings. Based on interviews with Indigenous housing stakeholders, it argues that the outcomes of an ethopolitics in housing welfare are necessarily contingent in these milieus. The analytical framework of realist governmentality assists in capturing the relationship between government technologies and the actions of governable subjects. Specifically, new understandings of tenant reflexivity and resistance clarify why the prescribed tenant identity – the responsible tenant – fails to materialize in practice.
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Objectives: We surveyed young men on their experiences of police encounters and subsequent mental health. Methods: Between September 2012 and March 2013, we conducted a population-based telephone survey of 1261 young men aged 18 to 26 years in New York City. Respondents reported how many times they were approached by New York Police Department officers, what these encounters entailed, any trauma they attributed to the stops, and their overall anxiety. We analyzed data using cross-sectional regressions. Results: Participants who reported more police contact also reported more trauma and anxiety symptoms, associations tied to how many stops they reported, the intrusiveness of the encounters, and their perceptions of police fairness. Conclusions: The intensity of respondent experiences and their associated health risks raise serious concerns, suggesting a need to reevaluate officer interactions with the public. Less invasive tactics are needed for suspects who may display mental health symptoms and to reduce any psychological harms to individuals stopped.
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Over the past decade there has been a proliferation of work on homelessness by geographers. Much of this has been framed by the desire to connect discussions of homelessness to wider debates around gentrification, urban restructuring and the politics of public space. Though such work has been helpful in shifting discussions of homelessness into the mainstream geographical literature, too much of it remains narrowly framed within a US metric of knowledge and too closely focused upon the recent punitive turn in urban social policy. Here we advance instead a framework that recognizes the growing multiplicy of homeless geographies in recent years under policies that are better understood as multifaceted and ambivalent rather than only punitive.
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In this paper, we argue that the ‘crime control housing crisis’ which has engulfed social housing is qualitatively different from most previous and current understandings of housing crisis (which have been of a quantita tive nature, or been resolved to that). By contrast, the crime control housing crisis is a crisis precisely because it appears insoluble. All hous ing problems and policies now have to be legitimated by reference to this crime control housing crisis. The gaze of this crisis has been upon the ‘social’ sector, but that has also caused reflection on how to placate the crime control housing crisis in the private sector. It is this latter area that is the focus of the case study in the second part of this paper and starkly raises the central, deceptively simple, problematization for government: how to govern the ungovernable without being seen to govern. The case study concerns regulations promulgated by the Northern Ireland Housing Executive regarding the licensing of houses in multiple occupation. We argue that this regulation is symptomatic of a mutated ‘housing crisis’ in which the old questions of the adequacy of provision have been supplanted by new questions of responsibility for deviant behaviour.
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This paper problematises the emergence and functioning of the recent phenomenon of ‘supervised injection sites’ (SISs) as a case study of post-welfarist governmentality. We propose that SISs arose as an unprecedented intervention in the late 20th century to deal with the increasing challenge of ‘urban drug scenes’ towards public order interests ‘entrepreneurial city’. Under predominant discourses of ‘public health’ and ‘harm reduction’, SISs became possible within a wide variety of political interests as a technology for purifying public spaces of ‘disorderly’ drug users to present the ‘new city’ as an attractive consumption space. Thus, SISs can be meaningfully understood as one element of socio-spatial ‘exclusion’ of marginalised populations from urban cores to ghettoised, peripheral spaces, even as they more benignly seek to better meet the unique needs of drug user populations. Further, the inner workings of SISs illustrate these facilities as powerful surveillance and discipline sites, defining the drug user as an agent of omnipresent risk being responsibilized in the care of the self and body, but also multiple aspects of behaviour and lifestyle reaching beyond drug use; thus construing the drug user as a ‘normalised’ citizen/consumer. We suggest that pressures to answer to powerful interests promoting ‘order’ are concretised as practices of ‘risk management’ ‘on the shop floor’, raising serious questions about the extent to which the ability to meet user needs is compromised in the interest of social control, surveillance, ‘management’, ‘education’, and ‘rehabilitation’, particularly in the current socio-political context (characterised as it is by a persistence, and indeed concomitant hardening, of repressive measures ‘on the street’).
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In the last two decades, provincial and local governments in Canada took a new series of measures to regulate urban disorder and control how public spaces were used by homeless people. Ontario became the first province to adopt new legislation with the passage of the Safe Streets Act, 1999. British Columbia soon followed the same path and enacted its own Safe Streets Act in 2004. This article focuses on the enforcement of the Safe Streets Act in Ontario and BC. Using quantitative data on tickets delivered to homeless people, it examines the extent of the penalization of homeless populations and establishes trends in the application of these statutes in both provinces. It concludes that the application reflects tensions around the visibility of homeless people in public spaces, particularly relating to squeegeeing, in both Ontario and British Columbia.
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The purpose of this chapter is to illustrate the centrality of the tabula rasa concept of self for the medical model of homeless service provision. Using four years of ethnographic data analyzed with a grounded fractal methodology, we illustrate the logical interconnections between the particular phenomena of homeless service institutions and broad cultural contexts. While social science has been somewhat critical of the medicalization of homelessness, its shared supposition about the self has relegated it to structural critiques that offer little to the currently homeless and those who want to help them. In contrast, we illuminate a path toward the development of an alternative pedagogy of individualism that is more directly responsive to the problematics of the medical model of homeless service provision.
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This paper uses Norbert Elias's theory of the civilizing process to examine trends in social conduct in the UK and to identify how problematic “anti‐social” behaviour is conceptualized and governed through housing‐based mechanisms of intervention. The paper describes how Elias's concepts of the formalization and informalization of conduct and the construction of established and outsider groups provide an analytical framework for understanding social relations. It continues by discussing how de‐civilizing processes are also evident in contemporary society, and are applied to current policy discourse around Respect and anti‐social behaviour. The paper uses the governance of “anti‐social” conduct through housing mechanisms in the UK to critique the work of Elias and concludes by arguing that a revised concept of the civilizing process provides a useful analytical framework for future studies.
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While current mainstream media stories oscillate between Canadian troops in Afghanistan attempting to restore safety and democracy and the imminent threat of a war on terror on domestic soil, a sorely neglected story concerns the con-tinued war on women in Canada. In this paper, we look at one site of this war—the case of missing and murdered women in Vancouver's Downtown Eastside. Employing a frame analysis, we analyze 128 articles from The Vancouver Sun pub-lished between 2001 and 2006. We argue that prevailing and historically entrenched stereotypes about women, Aboriginality, and sex-trade work continue to demarcate the boundaries of 'respectability' and degeneracy, interlocking in ways that situate these women's lives, even after death, in the margins. Résumé : Les reportages qui font la une présentent soit les troupes canadiennes postées en Afghanistan tentant de rétablir la sécurité et la décromatie, soit la men-ace imminente d'une guerre contre la terreur en sol domestique. Il est pourtant une histoire délibérément occultée : la guerre sans fin que subissent les femmes au Canada. Cet article explore une facette de cette guerre—celle des femmes dis-parues et assassinées du Downtown Eastside de Vancouver. Conduite à partir d'une méthodologie analytique, cette étude compile 128 articles tirés du Vancouver Sun entre 2001 et 2006. Notre enquête révèle que les stéréotypes his-toriquement ancrés prévalant aux sujets des femmes, Autochtones et tra-vailleuses du sexe ne cessent de démarquer les limites entre « respectabilité » et dépravation, de manière telle que mîme décédées la vie de ces femmes se situe en marge.
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North America's first supervised injection facility (SIF) was established in Vancouver, Canada, in 2003. Although evaluation research has documented reductions in risk behavior among SIF users, there has been limited examination of the influence of operational features on injection drug users' access to these facilities. We conducted an ethnographic study that included observational research within the SIF, 50 in-depth individual interviews with SIF users, and analysis of the regulatory frameworks governing the SIF. The government-granted exemption allowing the facility to operate legally imposes key operating regulations, as well as a cap on capacity, which results in significant wait times to enter the injecting room. Regulations that prohibit practices that are common in the local drug culture also negatively affect SIF utilization. Restructuring policies that shape the operation of the SIF could enhance access to the facility and permit SIF services to better accommodate local drug use practices.
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It is now widely argued that the contemporary city is becoming an increasingly hostile environment for homeless people. As basic street survival strategies are criminalized and public space 'purified' of those whose 'spoiled' identities threaten to 'taint' fellow members of the public, city authorities seem to have turned from a position of 'malign neglect' to more obviously punitive measures designed to contain and control homeless people. Less widely acknowledged but equally prevalent, however, is a parallel rise in the 'urge to care'; evident in the growing number of night shelters, hostels and day centres emerging in recent years to provide shelter and sustenance to homeless people. This paper contributes to a small but growing body of work examining the development of the 'spaces of care' springing up in the interstices of a 'revanchist' city, by examining the development and internal dynamics of day centres for homeless people in the UK. Drawing upon a national survey of service providers, and a series of interviews and participant observations with day centre staff and users, the paper argues that day centres act as important sources of material resource and refuge for a highly stigmatized group. However, it warns against the romantic tendencies implicit in the notion of 'spaces of care', emphasizing that what for one person may operate as a 'space of care' might, for another, be experienced as a space of fear. The paper concludes by noting the ambiguity and fragility of such spaces within the wider 'revanchist' city.
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The only randomised controlled trial to test high-fidelity assertive community treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from community mental health teams in reducing the need for in-patient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.
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Poverty management involves organized responses by elites and/or the state to contain potentially disruptive populations. As a result of global, national, and institutional compressions, the new poverty management tends to circulate these populations, especially the mentally disabled, across an array of unrelated and frequently institutional settings. This restructuring of interactions between mobility and institutional settings, in the form of institutionalized cycling, has yet to be investigated for other potentially vulnerable groups, such as single homeless women. Using a convenience sample of twenty-five women at a shelter in Central Los Angeles, I seek to understand their residential patterns, identify evidence of institutionalized cycling through a fivefold typology, and to elucidate the personal and structural factors behind why some women were prone to institutionalized cycling whereas others were not. Results point to highly uneven evidence of institutionalized cycling across the sample, with the most obvious impacts in the institutional cycler and institutionally accommodated categories.
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Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.
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The rise of neoliberalism in the 1970s and its consequences for housing policy have long interested researchers. This study treats neoliberalism as a discursive practice that produces knowledge, including our knowledge of the past. Using a Foucauldian approach to the analysis of historical files housed in the archives of one Australian state, I examine the emergence of the “failed” broadacre public housing estate as an object of discourse. I argue that this object emerged as a localized effect of a reconfiguration in what Foucault refers to as the “discursive constellation” which placed neoliberalism at a higher level within that constellation. The effect was to change the conditions of possibility for the production of knowledge within lower discursive levels, and in the case of housing policy, it became difficult to know that broadacre development was anything other than a mistake and a failure. I argue that widespread acceptance of this view within the policy community today arises from a set of relations between knowledge and power predicated upon particular discursive rules and procedures of control. Recognition that our knowledge is conditional is the first step in a process of critique that can transform our responses to locational disadvantage, poverty and stigmatization.
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This paper analyses changes in the conceptualization of “homelessness” in Australian policies, programmes and services from the 1970s to 2006. Research and commentary confirm a shift away from an understanding of homelessness in terms of “structural”, social and economic factors to an understanding in terms of “individual” issues. Research reflects this dichotomy, but attempts to reconcile the two explanations have failed in practice. Using Foucault’s work on governmentality, historical official statements and in-depth interviews, I show how changing policies and programmes, involving an extension and reconfiguration of political power beyond the state, had a constructive role in shaping “homelessness”. This “welfare reform” characterized homelessness as dependency, and programmes increasingly focussed on producing a managed form of self-reliance, shifting the conceptualization of homelessness towards individual explanations.
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In Vancouver, British Columbia, Canada's third largest city, the Vancouver Police Department (VPD), has positioned itself as being at the forefront of mental health regulation. The VPD problematization of the "mental health crisis" in Vancouver draws on discourses of addiction and dangerousness. This is partially achieved by the twinning of mental health with addiction (dual diagnoses) and a focus on illegal drug consumption, and is supported through law enforcement's role as active claims-makers. Consequently, there is a mobilization of resources to identify, discipline, and contain people identified as mentally ill and addicted with little examination of both the textual and visual discourses that serve this purpose. This article addresses this gap through an analysis of the images and discursive framing of people with mental illness and addictions by the VPD in two Vancouver Police Department reports published in 2008 and 2009. Copyright © 2015 Elsevier B.V. All rights reserved.
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In Canada and other western nations there has been an unprecedented expansion of criminal justice systems and a well documented increase in contact between people with mental illness with the police. Canadian police, especially in Vancouver, British Columbia (BC), have been increasingly at the forefront of discourse and regulation specific to mental health. Drawing on critical discourse analysis, this paper to explores this claim through a case study of four Vancouver Police Department (VPD) policy reports on ‘Vancouver’s mental health crisis’ from 2008 to 2013, which include recommendations for action. Analyzed is the VPD’s role in framing issues of mental health in one urban space. This study is the first analysis to critically examine the VPD reports on mental health in Vancouver, BC. The reports reproduce negative discourses about deinstitutionalization, mental illness and dangerousness that may contribute to further stigma and discrimination of persons with mental illness. Policing reports are widely drawn upon, thus critical analyses are particularly significant for policy-makers and public health professionals in and outside of Canada.
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Background: Due to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consideration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women. Methods: We report data from a qualitative interview study (n=30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs. Results: Women in the study lived in a range of SRO built environments, from publicly funded, newly built SROs to privately owned, dilapidated buildings, which presented a rich opportunity for ethnographic comparison. Applying Rhodes et al.'s framework of socio-structural vulnerability, we explore how SROs can operate as "mental health risk environments" in which macro-structural factors (housing policies shaping the built environment) interact with meso-level factors (social relations within SROs) and micro-level, behavioral coping strategies to impact women's mental health. The degree to which SRO built environments were "trauma-sensitive" at the macro level significantly influenced women's mental health at meso- and micro-levels. Women who were living in SROs which exacerbated fear and anxiety attempted, with limited success, to deploy strategies on the meso- and micro-level to manage their mental health symptoms. Conclusion: Study findings underscore the importance of housing polices which consider substance use in the context of current and cumulative trauma experiences in order to improve quality of life and mental health for unstably housed women.
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How is inner city space represented and by whom? Drawing from an extensive framing analysis of print media portrayals of Vancouver’s Downtown Eastside between 1996 and 2008, we offer a detailed assessment of the predominately negative portrayal of the neighbourhood, and the centrality of three frames: medicalization, criminalization, and socialization. Certain social actors are given a privileged position in the media in the representation of the inner city. Outsiders are privileged over insiders, with the neighbourhood constituted as a problematic space and its residents as passive victims. The effect is to further the stigmatization of an already marginalized neighbourhood, and to accentuate the disempowerment of its residents.
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In an effort to dismantle the open drug market and improve public order, a large-scale police initiative named the Citywide Enforcement Team (CET), began in Vancouver's Downtown Eastside (DTES) on 7th April 2003. This research sought to assess the CET's impact upon drug consumption activities as well as access to sterile syringes and health services among injection drug users (IDUs). Ethnographic research methods including participant observation and semi-structured interviews were employed. Interviews were conducted with 30 individuals recruited from an ongoing cohort study of IDUs and nine individuals who provide health services to drug users. In addition, an ongoing participant-observation program investigating public drug use in the DTES yielded data during the period of the CET, as well as seven months prior to its commencement. With regard to drug use patterns, intensified police presence prompted 'rushed' injections, injecting in riskier environments, discouraged safer injection practices, and increased unsafe disposal of syringes. Service providers indicated that the CET negatively impacted contact between health services and IDUs, as outreach was compromised due to the displacement of IDUs. Police activities also negatively influenced IDUs' access to syringes and their willingness to carry syringes, and syringe confiscation was reported. The intensification of police activities led to less drug related activity in the area where the drug market was traditionally concentrated, but widespread displacement of drug use activities to other locations also occurred. The adverse impact of concentrated police activities upon urban drug problems and the implications for both public order and public health should be recognized. (c) 2005 Elsevier B.V. All rights reserved.
Article
This article examines the influence on policing in Sydney, Australia of the crime control strategies developed in New York City in the 1990s, which are popularly credited with having significantly reduced crime rates. The ‘New York miracle’ is considered as an ‘enthusiasm’, a positive relation of the moral panic. Claims that the NYPD reduced crime with a strategy based on ‘zero tolerance’ or ‘broken windows’ are critically examined. The second half of the article presents a case study of how international developments in policing impacted on a heroin market in Cabramatta, a suburb of Sydney which, in the 1990s, became known as Australia’s ‘heroin capital’. The study shows how transferred policies are implemented, how elements of them may conflict, and how the crucial transfer may be not so much of particular policies, but rather of less specific perceptions and attitudes, in this case a confidence in the ability of police to reduce crime. It concludes by focusing on the collateral damage (particularly to public health) caused by police crackdowns on drug markets. Research is reported which found an alarming increase in the incidence of hepatitis C among intravenous drug users as a result of policing activity in Cabramatta.
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This paper explores the ways in which drop-in centres may at times function as spaces of care in the city. Drawing on participant observation research within a particular centre in Bristol, a city in south-west England, it focuses upon social relations within the drop-in space and the various subjectivities that were observed to emerge in this relational environment. Through a consideration of individuals who appeared to be positively assisted by their involvement in the drop-in, a sense is developed of the different ways in which such agencies may function as spaces of care. Use is made of Carl Rogers' notion of the core conditions for successful therapeutic encounter, as developed within the person-centred school of humanistic psychotherapy, to explicate these positive experiences. At the same time it was clear that some individuals found the drop-in to be a less than comfortable or even exclusionary environment. The paper concludes by reflecting on the broader significance of drop-in centres as caring environments and on the value of humanistic conceptions of therapeutic relation for interpreting organizational spacings of subjectivity.
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Public discourses on health increasingly emphasise the environment. While harm reduction has developed in parallel with the new public health movement, and both seek to encourage risk reduction by promoting individual and community action as well as environmental change, there remains an over reliance on individualistic modes of behaviour change. This commentary offers the concept of the ‘risk environment’ as a potentially useful framework for understanding and reducing drug-related harm, especially HIV infection associated with drug injection. It is argued that a shift in focus towards the ‘risk environment’ as a unit of analysis and change helps to overcome the limits of individualism characterising most HIV prevention interventions as well as to appreciate how drug-related harm intersects with health and vulnerability more generally. This in turn raises the importance of ‘non-drug’ and ‘non-health’ interventions for harm reduction and the facilitation of alliances between harm reduction and other social movements oriented to tackling vulnerability as a means of promoting public health.
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IntroductionSingle room occupancy (SRO) hotel units represent the most basic shelter provided for low-income individuals living in Vancouver's Downtown Eastside (DTES). While homelessness and marginalized housing in general, have been identified as environments that facilitate HIV risk behaviours, less attention has been paid to the specific context of living in SRO hotels. This analysis was therefore undertaken to describe the characteristics of individuals living in SRO hotels and to explore the association between living in SRO hotels and health status.
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In Canada, Provincial Governments have jurisdiction over delivery of healthcare including harm reduction services and Methadone Maintenance Therapy (MMT). While policy directives and funding come from the provincial capital, individuals' access to these services happens in neighbourhoods and municipalities spread out across the province. In some cases, public health objectives targeted at people living with addictions and the rights to equitable access to healthcare are at odds with the vision that residents, business associations and other interest groups have for their neighbourhood or city. This paper looks at the cases of four British Columbia municipalities, Mission, Surrey, Coquitlam and Abbotsford, where local governments have used zoning provisions to restrict access to harm reduction services and drug substitution therapies including MMT. This paper will contextualize these case studies in a survey of zoning and bylaw provisions related to harm reduction and MMT across British Columbia, and examine the interplay between municipal actions and public discourses that affect access to healthcare for people living with addictions. Finally, this paper will explore possible legal implications for municipalities that use their zoning and permitting powers to restrict access to health care for people with addictions, as well as public engagement strategies for healthcare advocates that have the potential to reduce resistance to health services for people living with addictions in communities across the province.
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The American Indian Quarterly 27.3 (2003) 593-606 Anyone passing through inner-city Vancouver on foot, on a bus, or in a car cannot help but SEE, in a literal sense, the concentration of Aboriginal people here. For most urban Canadians, and visitors from elsewhere, this is an unusual and often surprising visual experience on which they feel compelled to remark. Even so, many representations of this and other inner-city neighborhoods in Western Canada are characterized by a marked invisibility of Aboriginal people, and women in particular. This essay describes both the construction of this invisibility in public culture, and an event that symbolizes Aboriginal women's active resistance to these acts of erasure. Academic, professional, public, and popular discourses deploy a plethora of identifying labels and categorizations that obscure and depoliticize the embodied nature of colonialism that evidences itself in inner-city Vancouver, Canada. The annual Valentine's Day Women's Memorial March gives political expression to a complex process through which Aboriginal women here are struggling to change the language, metaphors, and images through which they come to be (re)known as they emerge into public visibility. The demand for recognition and respect articulated in the flyer quoted from above encompasses a critique and redefinition of dominant representations of Aboriginal women that are deeply embedded in Canadian colonial history and culture, as well as a claim for inclusion in the larger Aboriginal struggle for rights in place and to health, dignity, and justice. The intersection of Main and Hastings streets—known locally as "Pain and Wastings"—marks the heart of Vancouver's inner-city neighborhood: the Downtown Eastside. Since 1997, when the City of Vancouver Health Department declared a public health emergency in response to reports that hiv infection rates among residents exceeded those anywhere else in the "developed" world, Downtown Eastside Vancouver has become a focal point in emerging local, national, and international debates about the causes of, and solutions to, widespread practices of intravenous injection of illicit drugs and the spread of HIV/AIDS. Public health and law enforcement authorities, in an effort to respond to these "twin epidemics" have treated the Downtown Eastside as a containment zone, rather than as an enforcement zone: few if any arrests are made for simple possession or trafficking of small quantities of illegal drugs, or for soliciting for the purposes of prostitution. An open, publicly visible street market in illicit drugs and commercial sex has mushroomed. Predictably, national and international media as well as a surfeit of both well-intentioned and/or brashly self-promoting artists, writers, and researchers have been drawn as moths to flames to document, analyze, represent, treat, and market the dramatic and photogenic spectacle of social suffering in this neighborhood. A favorite focus of the cameras and interviewers is the southwest corner of Main and Hastings streets: the entranceway to the Carnegie Community Centre. Television and video crews offer the virtual voyeur disturbing—or titillating—images of emaciated heroin, crack cocaine, and prescription drug users buying, selling, injecting, and smoking. Young women hurry back and forth between this corner and others, in and out of alleyways, cars, and parking lots. The money women make selling sexual services passes quickly through their fingers from "Johns" to drug dealers. On one day of the year, though, for at least a few hours, the scene at Main and Hastings is dramatically altered. In 1991, Aboriginal and non-Aboriginal women's organizations in inner-city Vancouver declared February 14 a day of remembrance to honor neighborhood women who have been murdered or who have disappeared. In the Downtown Eastside, Valentine's Day has been transformed into an occasion to protest against racism, poverty, and violence against women, and to celebrate resistance, solidarity, and...
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In Overseers of the Poor, John Gilliom confronts the everyday politics of surveillance by exploring the worlds and words of those who know it best-the watched. Arguing that the current public conversation about surveillance and privacy rights is rife with political and conceptual failings, Gilliom goes beyond the critics and analysts to add fresh voices, insights, and perspectives. This powerful book lets us in on the conversations of low-income mothers from Appalachian Ohio as they talk about the welfare bureaucracy and its remarkably advanced surveillance system. In their struggle to care for their families, these women are monitored and assessed through a vast network of supercomputers, caseworkers, fraud control agents, and even grocers and neighbors. In-depth interviews show that these women focus less on the right to privacy than on a critique of surveillance that lays bare the personal and political conflicts with which they live. And, while they have little interest in conventional forms of politics, we see widespread patterns of everyday resistance as they subvert the surveillance regime when they feel it prevents them from being good parents. Ultimately, Overseers of the Poor demonstrates the need to reconceive not just our understanding of the surveillance-privacy debate but also the broader realms of language, participation, and the politics of rights. We all know that our lives are being watched more than ever before. As we struggle to understand and confront this new order, Gilliom argues, we need to spend less time talking about privacy rights, legislatures, and courts of law and more time talking about power, domination, and the ongoing struggles of everyday people.
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Thesis (Ph. D.)--York University, 1999. Includes bibliographical references.
Article
A 'risk environment' framework promotes an understanding of harm, and harm reduction, as a matter of 'contingent causation'. Harm is contingent upon social context, comprising interactions between individuals and environments. There is a momentum of interest in understanding how the relations between individuals and environments impact on the production and reduction of drug harms, and this is reflected by broader debates in the social epidemiology, political economy, and sociology of health. This essay maps some of these developments, and a number of challenges. These include: social epidemiological approaches seeking to capture the socially constructed and dynamic nature of individual-environment interactions; political-economic approaches giving sufficient attention to how risk is situated differentially in local contexts, and to the role of agency and experience; understanding how public health as well as harm reduction discourses act as sites of 'governmentality' in risk subjectivity; and focusing on the logics of everyday habits and practices as a means to understanding how structural risk environments are incorporated into experience. Overall, the challenge is to generate empirical and theoretical work which encompasses both 'determined' and 'productive' relations of risk across social structures and everyday practices. A risk environment approach brings together multiple resources and methods in social science, and helps frame a 'social science for harm reduction'.
Article
This paper critically evaluates, through use of covert ethnographic materials, an inner-city drop-in as a semi-institutional place where the identities of people with mental health problems are influenced by social processes of inclusion and exclusion. It is demonstrated, through an in-depth interpretative approach, that it is possible to understand more about the micro-geographies which make up deinstitutionalized landscapes, and about the social relations which characterise these. Key to this paper are findings which indicate that people with mental health problems cannot be understood as a straightforwardly homogeneous 'excluded' grouping, and that mainstream processes of boundary maintenance are in operation among these constructed 'others'.
Article
The Reasonable Person Model is a conceptual framework that links environmental factors with human behavior. People are more reasonable, cooperative, helpful, and satisfied when the environment supports their basic informational needs. The same environmental supports are important factors in enhancing human health. We use this framework to identify the informational requirements common to various health-promoting factors that are realizable through well-designed physical environments. Environmental attractors, support of way-finding, and facilitation of social interaction all contribute to the health-relevant themes of community, crime, and mode of transportation. In addition, the nearby natural environment, although often neglected, can serve as a remarkably effective resource.
Article
The built environment has direct and indirect effects on mental health. Highrise housing is inimical to the psychological well-being of women with young children. Poor-quality housing appears to increase psychological distress, but methodological issues make it difficult, to draw clear conclusions. Mental health of psychiatric patients has been linked to design elements that affect their ability to regulate social interaction (e.g., furniture configuration, privacy). Alzheimer’s patients adjust better to small-scale, homier facilities that also have lower levels of stimulation. They are also better adjusted in buildings that accommodate physical wandering. Residential crowding, (number of people per room) and loud exterior noise sources (e.g., airports) elevate psychological distress but do not produce serious mental illness. Malodorous air pollutants heighten negative affect, and some toxins (e.g., lead, solvents) cause behavioral disturbances (e.g., self-regulatory ability, aggression). Insufficient daylight is reliably associated with increased depressive symptoms. Indirectly, the physical environment may influence mental health by altering psychosocial processes with known mental health sequelae. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment. More prospective, longitudinal studies and, where feasible, randomized experiments are needed to examine the potential role of the physical environment in mental health. Even more challenging is the task of developing underlying models of how the built environment can affect mental health. It is also likely that some individuals may be more vulnerable to mental health impacts of the built environment. Because exposure to poor environmental, conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities, we also need to focus more attention on the health implications of multiple environmental risk exposure.
Article
Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research. Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic. Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views. Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.