Abstract

In this article, we conduct an empirical ethics approach to unravel the different perspectives on good care that are present in a community mental health team (CMHT) in Utrecht. With the deinstitutionalisation of mental health care, the importance of a close collaboration between the social and medical domains of care on the level of the local community is put in the foreground. Next to organisational thresholds or incentives, this collaboration is shaped by different notions of what good mental health care should entail. Using the concept of modes of ordering care (Moser 2005), we describe five modes of ordering mental health care that are present in the practice of the CMHT: the medical specialist, the juridical, the community, the relational and the bureaucratic perspective. These different modes of ordering care lead to frictions and misunderstandings, but are mutually enhancing at other times. Unravelling these different modes of ordering care can facilitate collaboration between professionals of different care domains and support a mutual understanding of what needs to be done. More so, the analysis foregrounds that ordering care from a relational approach is important in daily practice, but is in need of stronger legitimation.

Highlights

  • How should we care for people with severe mental illness in the community? This question about how to shape deinstitutionalisation is often addressed in organisational terms

  • This paper addresses the question from an empirical perspective on care practices: we describe how a team of health-­care professionals in Utrecht, the Netherlands shape care in the community for people with severe mental illness (SMI)1 and where this leads to problems

  • We ask ourselves which different modes of ordering mental health care are present in the practice of the Community Mental Health Team (CMHT) and we analyse how these modes suggest different types of problems that require particular solutions in order to create good care

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Summary

Introduction

How should we care for people with severe mental illness in the community? This question about how to shape deinstitutionalisation is often addressed in organisational terms. This paper addresses the question from an empirical perspective on care practices: we describe how a team of health-­care professionals in Utrecht, the Netherlands shape care in the community for people with severe mental illness (SMI) and where this leads to problems. We show how the different modes of ordering care relate to each other –­sometimes in a mutually enhancing way, but sometimes leading to friction and misunderstandings about how to proceed. By articulating these tensions, we hope to clarify what is at stake. Care is decentralised into different CMHTs, in which specialised mental health treatment and supported living teams work side-b­ y-­side to provide care in the community for people with SMI (Taskforce EPA Midden Westelijk Utrecht, 2015). The other aim is making care more accessible by decentralising mental health care to local communities

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