Crisis, what crisis? A multi-sited ethnography of community mental health care around a psychiatric crisis in Trieste and Utrecht

In this thesis, I describe and contrast the daily care practices of two community mental health care teams (CMHT). One is located in Trieste, Italy, and the other in Utrecht, the Netherlands. I study these care practices to learn more about how a psychiatric crisis can be dealt with outside the walls of a psychiatric hospital and what is perceived as “good” mental health care by those involved. Applying an empirical ethics approach, with ethnography as the main method, enables me to describe how good care gets its meaning within the relationship between patients, formal and informal caregivers, and their environment.
I choose to compare the care practices of the CMHT of Trieste and Utrecht because we know from previous research that they differ on some critical points. These are the number of psychiatric hospital beds and the use of coercion. Also, the way the two teams try to create continuity of care differs. While in Trieste the emphasis is on continuity in relationships, in Utrecht the teams try to create continuity of care by connecting different partners and expertise.
By contrasting the two practices, I argue that we need to shift our focus from acute moments and ways of controlling risks towards a broader time frame. This way, a crisis can be understood as a part of a longer trajectory instead of an isolated event. I consider care as working on a network of mutually interdependent relationships as an important way to deal with a crisis in a community setting, especially for those with more complex needs.