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 between professionals of different care domains and support a mutual understanding of what needs to be done. More so, the analysis foregrounds that ordering care from a relational approach is important in daily practice, but is in need of stronger legitimation.
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The tensions between the two modes do not arise on a level playfield. Ordering care as a medical specialisation is supported by the idea of evidenced‐based working and the DBC bureaucratic way of ordering care, while ordering care from a relational perspective has no such strongly articulated legitimation and a lack of professional specialisation. This distinction is strengthened by the policy decision to finance treatment and support separately. This lack of legitimation makes a lot of the daily relational work of the CMHT’s clinical nurses and case managers precarious; nevertheless, the need to work in this way is often clear to all involved.
© 2021 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL)