Beyond Care Avoidance and Care Paralysis: Theorizing Public Mental Health Care

Abstract

Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in this article identified as care paralysis. The aim of this article is to understand the production and reduction of care avoidance and care paralysis. Care avoidance and care paralysis not only coincide, they reinforce and recall each other. Trust and initiative -the opposite of avoidance and paralysis -are affirmed under conditions as an experienced proximity between the local population and care facilities and the committed involvement of professionals to a bounded territory. Trust and initiative also coincide, reinforce and recall each other. The existence of a safety net like Public Mental Health Care is closely linked to the absence of this vitality.

On the frontline or on the side-line? Homelessness care and care avoiders

“…Second, the research shows that in practice, homeless people entering regular homelessness care generally have to comply to a specific profile (see also Schout et al, 2011).…”

Public mental healthcare: towards a superfluous safety net

“…Social care (for housing, income and activities) and medical care (for addiction, mental and physical health problems) ought to be addressed simultaneously, but the complexity of rules and infrastructure and the budgeting of services hinder integrated care. Often regulatory barriers, thresholds, waiting lists and lack of insurance hamper access to healthcare (Schout et al, 2011). Moreover, the WHO (2008) points out that professionals in a market-driven healthcare system hinder the involvement of civil society (see also Stadelmann-Steffen, 2011).…”

“…In a previous paper we have described the problems of fragmentation, overspecialization, and counterproductive competition explaining the rise of PMHC (Schout et al, 2011). In high-income countries with market-driven healthcare systems, services are tailored to insured individuals, the competition and specialization that comes along with it does not work well with integrated services and community-based provisions.…”

“…PMHC in the United States and other countries with market-driven healthcare systems serves as a safety net for uninsured clients and provides care that other agencies do not offer. Worldwide, the lack of a comprehensive, integrated and coordinated system of Community Mental Healthcare (CMHC) explains the need for a safety net such as PMHC (Schout, De Jong & Zeelen, 2011). PMHC provides care for all kinds of underserved groups such GerT SchouT, GIdeon de JonG as patients with dual diagnoses, illegal immigrants without insurance, mentally disabled and frail elderly people with complex health needs, isolated persons with poor daily living skills (Patel et al, 2006).…”

Ogenschijnlijk mislukte Eigen Kracht-conferenties bij mensen met beperkte hulpbronnen

“…Naast het netwerk bestaat dan ook het risico dat professionals gedesillusioneerd raken (vergelijk Schout et al, 2011;Sousa & Rodrigues, 2012). Twijfels over de duurzaamheid van het tijdens de conferentie opgestelde plan worden in meerdere case studies geuit.…”