How Long Does Madness Take? Time and the Construction of Mental Illness in Community Mental Health Work

How do temporal understandings shape the construction of social problems and the work of addressing them? This article takes up a social problem with an explicit time dimension – severe and persistent mental illness (SPMI) – to advocate for a focus on time in the analysis of social problems. Drawing on interviews with community mental health workers (n=100) and observations of a police department and a psychiatric emergency department, I show how the work of these organizations yields two distinct sociotemporal orders – what I deem pursuing quick closure for police and rushing to wait for emergency hospital staff. The sociotemporal orders influence how these workers construct and approach the problem of SPMI. While these sociotemporal orders enable coordination within organizations, they produce temporal incongruence across organizations, which leads to conflict and undermines wider system coordination. Because police and hospital staff are not on the same time, their organizations are not on the same page. This article underscores the extent to which local constructions of social problems carry temporal assumptions that have practical effects on the work of ameliorating such problems. I conclude by discussing how this temporal analysis provides insight into the operation of power in community mental health.