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Abstract
In the debate on coercion in psychiatry, care and control are often juxtaposed. In this article we argue that this dichotomy is not useful to describe the more complex ways service users, care professionals and the specific care setting interrelate in a community mental health team (CMHT). Using the ethnographic approach of empirical ethics, we contrast the ways in which control and care go together in situations of a psychiatric crisis in two CMHT's: one in Trieste (Italy) and one in Utrecht (the Netherlands). The Dutch and Italian CMHT's are interesting to compare, because they differ with regard to the way community care is organized, the amount of coercive measures, the number of psychiatric beds, and the fact that Trieste applies an open door policy in all care settings. Contrasting the two teams can teach us how in situations of psychiatric crisis control and care interrelate in different choreographies. We use the term choreography as a metaphor to encapsulate the idea of a crisis situation as a set of coordinated actions from different actors in time and space. This provides two choreographies of handling a crisis in different ways. We argue that applying a strict boundary between care and control hinders the use of the relationship between caregiver and patient in care.
Highlights
With the deinstitutionalizing of mental healthcare, there are concerns about how to care for a person experiencing a mental health crisis in the community [1, 2]
We turn to the contrasting practices in two community mental health teams (CMHTs): one CMHT in Trieste (Italy) and one team in Utrecht, and we explore how these practices relate care and control in different ways
Ethnography is chosen as a method because it offers the possibility of “studying at firsthand what people do and say in particular contexts,” [15] thereby allowing us to observe what is performed as the “good” [16] by those involved in care practices
Summary
With the deinstitutionalizing of mental healthcare, there are concerns about how to care for a person experiencing a mental health crisis in the community [1, 2]. Historical Background The “Trieste model” of mental healthcare that has developed since the 1970s is based on the ideas of Franco Basaglia (1924– 1980), an Italian psychiatrist He stated that the person with the mental illness—and not the disorder—should be placed at the center of the mental health system. In the 1970s he proposed a different way of organizing Trieste’s mental health system: closing the psychiatric hospital and making a radical shift toward organizing mental health care in the community by starting Community Mental Health Centers (CMHC) Important principles in this movement were offering a low threshold to care, working with open doors and minimizing coercion [19, 20]. The actual implementation of this law varied greatly between the various regions of Italy [21, 22]
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