Enforcing patient rights or improving care? The interference of two modes of doing good in mental health care (original) (raw)
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Sociology of Health & Illness, 2003
Abstract New state laws are intended to bring about formal changes. These juridical activities inevitably interfere with the content of care of substantially changing health care practice. The case is argued by means of an analysis of ethnographic material gathered in the long-stay wards of two psychiatric hospitals in the Netherlands. The question raised by the ethnography is which ‘mode of doing good’, juridical or caring, is relevant to daily practice. A ‘mode of doing good’ is defined as a pattern of ideals, procedures, routines and knowledge that is oriented towards a specific form of ‘good care’. The interference of these different modes of doing good explains the impact of recent juridical changes in Dutch mental health care. The potential tensions between juridical and caring traditions are accommodated in different ways. Either juridical and caring modes resonate and gradually merge into new patterns of day-to-day practice, or there is dissonance and they remain oppositional. Rather than securing patient rights, juridical measures change daily life and work on the wards in far more complex ways.
Sociology of Health & Illness, 2021
In this article, we conduct an empirical ethics approach to unravel the different perspectives on good care that are present in a community mental health team (CMHT) in Utrecht. With the deinstitutionalisation of mental health care, the importance of a close collaboration between the social and medical domains of care on the level of the local community is put in the foreground. Next to organisational thresholds or incentives, this collaboration is shaped by different notions of what good mental health care should entail. Using the concept of modes of ordering care (Moser 2005), we describe five modes of ordering mental health care that are present in the practice of the CMHT: the medical specialist, the juridical, the community, the relational and the bureaucratic perspective. These different modes of ordering care lead to frictions and misunderstandings, but are mutually enhancing at other times. Unravelling these different modes of ordering care can facilitate collaboration betwe...
Polish Journal of Public Health, 2017
A psychiatric hospital is a special place. People undergoing treatment are in a unique situation. Mental illness remains a mystery for scientists because we do not know what factors influence its appearance. There were also no drugs that would completely cure the patient, as you never know whether the medicine will affect a particular person. Mental illnesses evoke anxiety and fear of the community. Some patients take disturbing or dangerous actions. Their behaviors are referred to as specific and different ones. A similar situation is caused by the appearance of psychotic symptoms. One should pay attention to delusions and hallucinations here. These symptoms cause the patient’s situation to deteriorate. Ultimately, they can cause dangerous behavior. It happens that a relative of a patient, who is in such condition, must take action without his/her consent. A similar issue has been analyzed in Poland for almost thirty years. Individual regulations, in exceptional cases, allow for un...
Caring through discipline? Analyzing house rules in community mental health services in Norway
In Scandinavian countries, public housing and recreation programs for people suffering from mental health or substance abuse problems emphasize normalization of life and participation in a normal social life. The theoretical approach taken by community health care services has been de-institutionalization. To study if and how this movement from patient to fully participating citizen was reflected in these new institutions, written house rules in sheltered housing and day centers for adults were collected and analyzed by content analysis. The findings show that the formal language represents the voice of professionals, while the content pertained to regulation of the service user’s daily life. House rules mostly mediate an image of the service user as a person in need of being controlled, and the ideological practices of hospital-managed care seem to be maintained.
A practical ethics of care: Tinkering with different 'goods' in residential nursing homes
Journal of Business Ethics, 2019
In this paper we argue that 'good care' in residential nursing homes is enacted through different care practices that are either inspired by a 'professional logic of care' that aims for justice and non-maleficence in the professional treatment of residents, or by a 'relational logic of care', which attends to the relational quality and the meaning of interpersonal connectedness in people's lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing 'goods'. This tinkering process, which unfolds through 'intuitive deliberation', 'situated assessments' and 'affective juggling' is then theorized along the conceptualization of a 'practical ethics of care': an ethics which makes no a priori judgements of what may be considered as good or bad care, but instead calls for momentary judgements that are pliable across changing situations.
Narratives of Coercion: Law as a social determinant of clinical interactions in mental hospitals
The purpose of this paper is to show the impact of a custodial / penal law on client-provider interactions in the mental health sector. Law is the macro environment within which the mental health system works. Mental hospitals , an over-determined mode of service provision in the country , have been instituted and regulated by the Mental Health Act , 1987. The Act is a peculiarity of the health sector. Unlike health care patients , who are distal from the universe of law and courts , psychiatric patients become medico- legal subjects the moment a psychiatric diagnosis is received. The MHA provides liberally for involuntary commitment into a mental hospital; the legal format and process of commitment is more like an arrest , and less like a critical health admission. The police have a role to play in mental hospital commitments , which is another peculiarity. The implications of having a penal law in a health sector has been critically examined ( most notably by Dhanda , 2000 ) . Through the punitive legal devices enshrined in the Act , psychiatric patients become high risk for state coercion , particularly involuntary incarceration and treatment . Custodialisation of people living with a mental illness is more than just law. It is an outlook and an attitude created in community care giving by the extant medico legal environment. A study ( Cremin , 2007 ) situating the place of law in non - institutional or private settings ( General Hospital Psychiatric Units and Rehabilitation Centers , for example ) showed that this environment is a great barrier to developing voluntary community mental health services. The MHA has influenced not only hospital administration but also the working contexts of care giving staff working therein. A picture of the dangerous and incapable mentally ill patient who has to be managed by force is perpetrated by the MHA , which the staff are expected to maintain. The law sets up expectations from care giving staff contrary to their own professional skills and ethics. India , the reform of the mental hospitals has always been seen as a legal matter settled by the higher courts ( Dhanda , 2000 ) , the human rights commission ( NHRC , 1999 ) or as public administrative measures by the Mental Health Authorities , the police and prison commissionerates , and other public machinery. Mental hospitals have not been mainstreamed in social science research , public health , and management literature , barring a few exceptions ( Mission Report , 2003 ) .
Good care: enacting a complex ideal in long-term psychiatry
2004
Examining Board Prof. dr. HJ Achterhuis Prof. dr. MHF Grypdonck Prof. dr. Prof dr. TJ Heeren Prof. dr. PJH Kockelkoren Prof. dr. P. Meurs Prof. dr. BE van Vucht-Tijssen (chair) dr. J. van Weeghel Prof. dr. D. Willems ... The research project of which this book is a result, was carried out ...