A recent investigative piece, “Out of Sight, Out of Mind” by Bonnie Schell, published on Mad in America, is reigniting discussion about how modern societies—particularly the United States—manage visibly unhoused and mentally ill populations. The article, released on July 28, 2025, details not only current US policies involving forced removals of homeless encampments but also traces the roots of these actions to a centuries-old history of social segregation, institutionalization, and medicalization. For Thai readers, this global narrative fuels reflection on how societies—perhaps even Thailand itself—balance public order, health, policy ethics, and human dignity.
The report opens with recent US events where, ahead of a major military parade in Washington, D.C., authorities issued 24-hour notices to clear tent dwellers from prominent public spaces. US policy under President Trump exemplifies a broader, recurring trend: making poverty and mental illness less visible, often by removal or forced institutionalization rather than resolving underlying social and economic drivers (madinamerica.com). Such efforts are not new. Tracing history back to classical philosophers like Plato, who advocated for the removal of “mad” individuals from city visibility, the article uncovers a continuous lineage of social policies that physically and socially segregate disadvantaged populations.
This deep-rooted practice evolved in 19th-century America with the construction of asylums—institutions often placed beyond city limits, designed both to “treat” and to contain those deemed unfit for public life. Over time, notorious legislation such as “Ugly Laws” criminalized poverty, disability, and mental disturbance, demonizing and punishing the presence of visible suffering in urban life. While these policies were enshrined in Western legal codes, versions of their logic can be seen worldwide—including in Southeast Asia—whenever the poor, disabled, or mentally ill are swept from streets before major public events or international gatherings.
The article highlights that these policies have also shifted forms. In the United States, while deinstitutionalization in the 1960s and 1970s was lauded as a step forward, it was not matched by sufficient investment in community-based alternatives, leaving thousands without adequate support. Instead, community resistance to mental health facilities and shelters has created so-called NIMBY (Not In My Backyard) barriers, siphoning off those most in need. Thailand’s mental healthcare reform likewise has struggled with balancing psychiatric hospital care and underfunded community mental health services (WHO Thailand).
Expert perspectives illuminate the consequences of forced removals and compulsory treatment. Advocacy groups like Human Rights Watch have voiced concern over recent policies in California, such as amendments expanding the legal basis for involuntary holds and forced medication of those deemed “gravely disabled.” International rights organizations stress that such measures risk violating individual autonomy and disproportionally targeting the poor and marginalized (hrw.org). The Mad in America report notes that these legal trends are accelerating with public anxieties about homelessness, often inflamed during politically sensitive moments or when international attention is anticipated.
A central theme is the medicalization of homelessness itself. Increasingly, authorities diagnose homelessness as a symptom of mental illness, particularly with disorders like schizophrenia. The use of diagnoses such as anosognosia—where someone is allegedly unaware of their mental illness—effectively paves the way for coerced treatment and institutionalization. Dr. Xavier Amador of NAMI, cited in the article, estimates that almost all individuals with true schizophrenia experience anosognosia, a view contested by advocates who fear overgeneralization and the risk of undermining personal agency. In Thailand, similar discussions have arisen about involuntary psychiatric admissions under the Mental Health Act and the thin line between treatment and human rights (Thai Mental Health Act, Department of Mental Health).
Another dimension explored is the profit-driven nature of the private mental health and pharmaceutical sectors. The article raises sharp questions about how pharmaceutical companies and for-profit mental health providers stand to gain from expanding forced medication and institutionalization. Recent clinical developments, such as aggressive marketing of new antipsychotic drugs like KAR XT, bring billions in profits but have mixed track records in real-world effectiveness. Meanwhile, developers of high-end mental health retreats for the wealthy further entrench the disparity in care, as seen in exclusive centers like Privé-Swiss and Tikvah Lake. Conversely, the poor are relegated to medication-first, often isolating regimes, with little access to ongoing social support.
These patterns intersect with the resurgence of old ideas: the proposal to create “Wellness Farms” for the unhoused, echoing institutional labor camps of the past, draws sharp criticism. Contemporary observers point out the risks of forced labor and lack of accountability—parallels eerily reminiscent of exploitative practices seen in the history of psychiatric hospitals and prison work programs.
For Thailand, the relevance of these findings cannot be overstated. As the kingdom continues to modernize and host high-profile international events, there is mounting pressure to clear public spaces of the visibly poor and unwell. Reports periodically surface of Bangkok city authorities relocating homeless individuals ahead of economic summits or tourist seasons (Bangkok Post). At the same time, Thailand faces dramatic rises in mental health issues linked to social upheaval, economic stagnation, and pandemic aftershocks (The Nation Thailand). The balancing act between safeguarding public order, ensuring equitable medical care, and upholding human rights remains delicately poised.
Cultural attitudes in Thailand further shape mental health and homelessness. Deep-rooted Buddhist concepts of karma have sometimes been used to morally distance the well-off from those experiencing suffering or behaving differently. The interplay between community-based care, traditional beliefs, and formal psychiatric practice presents unique challenges for Thai health and social policy makers (Asian Journal of Psychiatry). Yet, history also reveals moments of compassion, as local temples and civil society groups have offered refuge and informal care long before state systems intervened.
Looking ahead, the path Thailand and other countries choose will hinge on confronting painful realities: policies that treat symptoms while ignoring root causes, and medical approaches that sideline social justice. The intensification of surveillance, forced relocation, and forced medication risk eroding trust in institutions and further marginalizing the vulnerable. With global pharmaceutical and private healthcare interests influencing policy, the risk of profit superseding patient rights grows.
For policy makers, health professionals, and ordinary citizens alike, the lessons are clear. There is a moral imperative to design inclusive, rights-respecting systems that provide meaningful support—whether through well-funded community mental health services, safe and dignified homeless shelters, or accessible social protection for all. For Thailand, this may mean scaling up investment in mental health beyond hospital walls, strengthening social safety nets, and fostering public dialogue that replaces stigma with solidarity.
Practically, Thai readers can advocate for these changes by supporting NGOs working at the intersection of homelessness and mental health, volunteering at local shelters, and challenging stereotypes in daily conversations. Families experiencing mental health challenges can reach out to community health volunteers (อสม.) and take advantage of mental health hotlines provided by the Department of Mental Health (DMH Hotline 1323). Persistent calls for government transparency, accountability, and respect for human dignity are pivotal as Thailand navigates its own path in an increasingly unequal world.
For further details and deep historical analysis, the full original article is available at madinamerica.com.