Care in the time of crisis. An ethnography of care and coercive practices in acute mental healthcare contexts.
Author: Eleonora Rossero, eleonora.rossero@unito.it
Department: Department of Culture, Politics and Society
University: University of Turin, Italy
Supervisor: Mario Cardano
Year of completion: 2021
Language of dissertation: English
Keywords:
Mental health care
, Coercive practices
, Good care
, Ethnography
Areas of Research:
Health
, Mental Health and Illness
, Deviance and Social Control
Abstract
Today’s organization and provision of acute mental health care in Italy is characterised by great heterogeneity, particularly between ‘restraint’ and ‘no-restraint’ models (which do or do not adopt mechanical restraint). Two regions – Piedmont and Friuli Venezia Giulia – have been identified to respectively represent the two models. Participant observation and discursive interviews have been conducted to explore care and coercive practices in hospital and community services in the two regions. Findings of this comparative ethnography suggest that different institutional maps are in place, drawn through everyday boundary work around each service’s purpose. The profile of the population admitted to the psychiatric ward differs too, resulting from the construction of the ‘proper patient’ operated by multiple actors and the strategies they deploy to perform circulation work. With respect to coercive interventions, in both ‘restraint’ and ‘no-restraint’ contexts they appear either outsourced to external agents (i.e. police forces) or embedded in the notion of (good) care through four repertoires: i) therapeuticisation of coercion; ii) proceduralisation of coercion; iii) relationalisation of coercion; and iv) multiplication of the ‘objects of care’. Values and notions of ‘good care’ enacted in the two contexts are discussed, and situated suggestions for possible improvement of acute mental healthcare proposed.
