Homelessness as an Incurable Condition? The Medicalization of the Homeless in the Swedish Special Housing Provision

In Sweden, the prevailing model for combating homelessness has been, and to a large extent still is, the disciplining staircase model, which stresses absolute sobriety as a criterion for eligibility for municipally organized special housing. The model builds on a view of the homeless as individuals incapable of independent living, albeit ones who are (potentially) able to become capable of independent living and (at least theoretically) of securing an ordinary apartment for themselves on the regular housing market, with the help of discipline and self-regulation (by adhering to the principle of absolute sobriety and complying with a number of other rules). In the staircase model, self-regulation is characteristically seen as a necessary precondition for this gradual improvement in the help receivers’ housing standard, their increasing independence (living without rules, regulations, and surveillance), and the stability of their living situation more in general (Sahlin, 2005). Of the country’s population of nine million, approximately 17,800 are homeless, in the latest estimate of the National Board of Health and Welfare (National Board of Health and Welfare [NBHW], 2006). According to the same statistics, 62 percent of the homeless have problems with addiction and 40 percent suffer from a variety of mental disorders. The Board’s figures, however, likely fail to accurately capture the size and nature of the homeless problem in the country. Due to respondent selection issues in its survey, there was, for example, no way to adequately assess the number of homeless individuals not suffering from addiction or mental health problems; nor could the number of homeless families be ascertained. Nonetheless, if the results are to be trusted, in 2005 there were 2,620 homeless persons in Gothenburg, Sweden’s second largest city, with the municipality becoming singled out as having proportionally speaking the highest number of homeless in the country (54 homeless per 10,000 inhabitants). In subsequent years, new measures to combat homelessness have been introduced in a number of municipalities in the country. In 2007, for example, the city of Gothenburg officially abandoned the staircase model it had been using until then (see Hansen Lofstrand, 2010), adopting in its stead the so-called Housing First model, as it was named when originally launched in the United States (see Tsemberis et al., 2004). In Gothenburg, the new approach has thus far been limited to a few housing units assigned for the experimentation