Care in a Time of Crisis : An Ethnography of Coercive Practices in Italian Acute Mental Health Provision

The book presents the results of an ethnographic study examining the post-deinstitutionalized organization and provision of acute mental health care in Italy. While the achievements of the “Basaglia law” which imposed the closure of psychiatric hospitals in Italy in 1978 have been well-documented, this book sheds fresh light on its aftermath and possible continuing influence. The author examines two Italian regions – Piedmont and Friuli Venezia Giulia (internationally known to be the first Italian region to close down asylums) – respectively as representatives of the ‘restraint’ and ‘no-restraint’ models. Within each context, participant observation and discursive interviews have been conducted in Mental Health Centres (CSM) and acute psychiatric wards (SPDC) to explore care and coercive practices, as well as notions of ‘good care’ and values embedded in everyday working activities of these services. Situated suggestions for possible improvement of today’s acute mental health care are also proposed. This book offers a novel ethnography of mental health care in the Italian context that will appeal in particular to practitioners and scholars in the fields of critical mental health, cross-cultural psychology, the history of psychiatry and the sociology of health. Acknowledgements Contents About the Author Abbreviations List of Tables 1: Introduction 1.1 Exploring Care and Coercive Practices 1.2 Aims of the Research 1.3 Outline of the Book 1.4 Terminological Choices References 2: On Coercion in Inpatient Psychiatric Settings 2.1 Coercion in Psychiatric Settings: An Introduction 2.1.1 What Counts as Coercive? Defining and Justifying Coercion 2.2 Involuntary Admission and Treatment 2.2.1 Involuntary Admission and Treatment in Italy: “Trattamento Sanitario Obbligatorio” 2.3 Restraint and Its Multiple Forms 2.3.1 Contenzione: Mechanical restraint 2.3.2 Contenimento: Holding or Manual Restraint 2.3.3 The Sedative/Curative Divide: Pharmacological Restraint 2.3.4 Locked Versus Open-Door Wards: Environmental Restraint References 3: A Necessary Evil? Alternatives to Coercive Interventions 3.1 The No-Restraint Movement: A Historical Overview 3.2 Contemporary Attempts to Reduce Coercion in Psychiatric Settings 3.3 Defining the Object: Situated Care and Coercive Practices References 4: The Empirical Research: Context, Data, and Methods 4.1 Ethnographic Research on Acute Inpatient Psychiatric Settings: An Introduction 4.2 Investigating Coercion 4.3 Feeling the Field References 5: Crisis and Its Places: Boundary-making in and Around Mental Healthcare Services 5.1 The Birth of Community Mental Health Services: A Historical Look at Italian Deinstitutionalization 5.2 A Fundamental Dicothomy: ospedale Versus territorio 5.3 “We Are in the Hospital, but We Are Not Hospital”: A Narrative of “Otherness” 5.4 Places of Crisis: Institutional Maps and Wards’ Shape 5.4.1 Shape-Preservation Strategies: Circulation Work and Pertinence Permeability 5.5 Conclusion References 6: Combining Healthcare, Compassion, and Coercion Repertoires and Strategies to Provide (Good) Care in Acute Psychiatric Settings 6.1 Managing Crisis in and Outside the Hospital 6.1.1 The Pine Ward and the Iris Ward 6.1.2 The Violet and the Tulip Mental Health Centres 6.2 Outsourcing Coercion: Segregating Care and Coercion 6.3 Embedding Coercion: Performing Coercion as (Good) Care 6.3.1 Therapeuticization of Coercion 6.3.2 Proceduralization of Coercion 6.3.3 Relationalization of Coercion 6.3.4 Multiplication of the Objects of Care 6.4 Conclusion References 7: Care in the Time of Crisis 7.1 Preferability Between Restraining Practices 7.2 What’s Wrong with Mechanical Restraint? ‘Delegating’ Versus ‘Staying in the Relationship’ References 8: An Empirical Ethics Approach to Acute Psychiatric Care: Advancing “Situated Suggestions” References Appendix A The Ethnographic Fieldwork: Methodological Information References Appendix B Informed Consent: Letter for the Interviewees Appendix C Notation for Interviews Transcription and Quoted Excerpts Index