“Caring for a Crisis”: Care and Control in Community Mental Health

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.

The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises

“…The international scientific production highlights the need for a cultural change about what is meant by a crisis in mental health and how it should be addressed, as this is not just a crisis inherent to the person, but also to the context ( 4 , 23 ) . A number of research studies point out that the physical proximity of the services, the determinants of regular access to community care, and the preparation of the teams in this approach are essential to achieve positive results in crisis management in the community ( 21 - 22 ) .…”

“…along with possible preventive or care continuity interventions. The main objective of this program is to offer daily and singular care, closer and more flexible, so that users are fully assisted in their territory and, if they happen to present crises, these are overcome with less distress intensity ( 4 ) .…”

“…Even in scenarios such as Italy, the Netherlands, and Brazil, which implemented similar deinstitutionalization models with a focus on community care, the assistance provided for crises is still one of the most critical points in mental health care, which evidences the need to evaluate this practice ( 2 , 4 ) .…”

“…Internationally, the assessments of care services for drug users are based on programs and policies specific to each country ( 3 ) . Some common indicators ensure crisis care exclusively in the community environment and no relapses (new crises) ( 4 , 14 ) . Similarly, in Brazil, 24-hour CAPS evaluation indicators have been validated recently.…”

Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care

“…By preserving legal capacity, the CRPD obliges that the rights, will and preferences of people with disabilities are Valenti and Giacco BMC Health Services Research (2022) 22:1273 respected. However, there are suggestions that mental health care professionals (MHPs) struggle to implement fully collaborative approaches when working with community patients [2][3][4][5][6][7][8][9].…”