Choose, judge, and move on: The tensions arising from implementing personalized care for homeless people with mental health issues in the UK

Abstract

For the last decade, the UK government has followed an agenda of “personalizing care.” Based on ethnographic material from three hostels supporting homeless people with mental health issues in central London, I analyze tensions in the everyday implementation of this policy agenda: on the one hand, using tools such as personal budgets, personalization was practiced by providing people with short-term, concrete choices—between different care workers, activities, and housing options, for instance. On the other hand, the implementation involved developing judgment around longer-term plans, centered on how to “move on” people to independent living. What I describe as personalization’s focus on positive liberty is complicated by the consequences of mental health issues and the after-effects of long-term institutionalization. As a result, choice and judgment were often in tension with each other and more substantially with the residents’ desires for maintaining support and care, linked to a different kind of “freedom in dependence.”