Transinstitutionalization: A Feminist Political Economy Analysis of Ontario's Public Mental Health Care System
Haley, Elizabeth Tobin LeBlanc
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Feminist political economy (FPE) deepens our understanding of the nature and dynamics of marginalization confronting various social groups in late-capitalism. Scholars adopting an FPE approach have, however, neglected to scrutinize the arrangement of public mental health care systems under neoliberalism or prevailing understandings of mental illness in services and policy. Additionally, despite the recent emergence of Mad Studies, drawing further attention to the challenges facing consumers/survivors/ex-patients/Mad people under neoliberalism, FPE scholars have not substantively addressed this marginalization. FPE has much to offer studies of mental health care, as mental health care services are primarily services for daily maintenance, a central aspect of social reproduction, and are shaped by the prevailing arrangement of production. This dissertation draws on archival and documentary analysis and interviews in pursuit of an FPE analysis of Ontarios public mental health care system, both filling a gap in this field of inquiry and offering new insights into the state of mental health care in Ontario with the aim for forging positive social change. Drawing on FPEs conception of social reproduction, and focussing on mental health care services as a form of daily maintenance, my central contention is that downloading, privatization and individualization in the areas of mental health policy and service provisioning, together with concomitant changes to definitions of mental illness in policy and practice, have produced a new phase of mental health care in Ontario, namely transinstitutionalization. Transinstitutionalization is constituted through three distinct, but interrelated processes: 1) the application of the neoliberal imperatives of downloading, privatization, and individualization to existing services; 2) the structuring of mental health care services to condition independence in the activities of daily maintenance and, whenever possible, labour force attachment; and, 3) the development in policy and practice of new definitions of mental illness and recovery that encourage economic independence, producing a model of the ideal mental patient as one who can take control of their life and achieve independence. This dissertation first charts transinstitutionalization historically, then examines its constitution and operation in the areas of treatment, income support and housing services, the pillars of Ontarios public mental health care system.