Niching in cities under pressure. Tracing the reconfiguration of community psychiatric care and the housing market in Berlin

Abstract

Community psychiatry services in Berlin are currently facing serious challenges providing care to their clients due to a strained housing market and a lack of housing for people with low income or on welfare. Rather than using the word precarity to describe the effect of cuts in welfare state benefits and investments, we grasp precarity ethnographically as a situated, processual condition that emerges in urban assemblages. Based on long-term ethnographic fieldwork in community psychiatry and with people with a psychiatric diagnosis in Berlin, we elaborate on the entanglement of housing market development, gentrification processes and mental health care provision. Community psychiatry professionals especially face challenges securing decent housing for their clients in the inner-city; as a result they pressure them to keep disturbances to a minimum and keep inconspicuous clients in the mental health care system. We argue that precarity is contingently produced by the coming-together of urban developments and community psychiatry principles. As such, precarity itself is generative of shifts in mental health care practices, produces visible tensions within community psychiatry and unfolds in the everyday struggles of mental health care clients, resulting in ambiguous outcomes. To provide a relational analysis of precarity as lived experience and a condition of urban life, we introduce the notion of niching as a middle-range concept connecting conditions of precarity with what people make of it. This is complemented by an analysis of the socio-material practices that produce urbanism.