Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcar
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Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste Christien Muusse1,2 • Hans Kroon1,3 • Cornelis L. Mulder4,5 • Jeannette Pols2,6
The Author(s) 2020
Abstract Deinstitutionalization is often described as an organizational shift of moving care from the psychiatric hospital towards the community. This paper analyses deinstitutionalization as a daily care practice by adopting an empirical ethics approach instead. Deinstitutionalization of mental healthcare is seen as an important way of improving the quality of lives of people suffering from severe mental illness. But how is this done in practice and which different goods are strived for by those involved? We examine these questions by giving an ethnographic description of community mental health care in Trieste, a city that underwent a radical process of deinstitutionalization in the 1970s. We show that paying attention to the spatial metaphors used in daily care direct us to different notions of good care & Christien Muusse [email protected] Hans Kroon [email protected] Cornelis L. Mulder [email protected] Jeannette Pols [email protected] 1
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
2
Section of Medical Ethics, Department of General Practice, UMC Amsterdam, Amsterdam, The Netherlands
3
Tranzo, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
4
Erasmus MC, Rotterdam, The Netherlands
5
Parnassia Psychiatric Institute, The Hague, The Netherlands
6
Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Cult Med Psychiatry
in which relationships are central. Addressing the question of how daily care practices of mental healthcare outside the hospital may be constituted and the importance of spatial metaphors used may inform other practices that want to shape community mental health care. Keywords Deinstitutionalization Empirical ethics Community mental healthcare Spatial metaphors Care collectives
Introduction Along the coastline of Trieste, on the western side of the city, a busy street runs into the center. Along it lie some bars, an expensive hotel, a restaurant and a church. A bit further down is a popular place where Triestiani go for a swim in the sea on warm days. One building is an old, yellowish villa surrounded by a garden. Go through the porch, and you will find a large table in the garden where people sit chatting and smoking cigarettes. The house itself is a two-floor building, with a small balcony just above the entrance. You are now entering Trieste’s first community mental health center, a place with an interesting history. Since the 1970s, Trieste, a city high in Italy’s northeast, has been the stage for visitors from all over the world inspired by the way community mental health is done there. The so-called ‘Trieste model’ of mental health care that has been in constant development since then, was inspired by t
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