Solutions from everyday life: good care(s) in the context of caring for severe mental illness in Portugal

Abstract

Introduction: In Portugal and many European countries, caring for mental illness is frequently encapsulated in what some call the psy complex [1] , centered in the hospital. Even if there have been efforts for deinstitutionalization, successive delays in restructuring services and little interest from the political, public, and scientific fields [2] have contributed, for decades, for the lesser visibility of what it means to experience mental illness, and other ways of dealing with it beyond the hospital and psychiatry. Indeed, closing psychiatric institutions and changing to a community paradigm, includes creating other structures and components for rehabilitation and inclusion that would allow keeping people with psychosocial difficulties in the community. These also mean rehabilitating the patient, his/her relatives and the professional, as they shall operate in a new rehabilitative-communitarian model – putting them, even temporarily, somewhere in between this and the old bio-medical model, raising tensions and unexpected consequences.

Materials and methods: This presentation is empirically based on an ethnographic study, which included 6-month daily participant observation, from April to October 2016, in two ambulatory units of a Psychiatry Department in a Portuguese general hospital, and interviews with users of these units. During this time, I participated in all the activities that these units provided in terms of care, social rehabilitation, or social events, as well as team/department meetings. All the people with whom I worked there were aware of my role as researcher and the project I was developing there. During these months, I have documented the daily routines of ambulatory psychiatric treatment, materialized by patients, relatives, professionals and in physical surroundings. Fieldnotes were analyzed from the starting point of finding points of tension/uncertainty in the provision of care and highlighting the solutions found by participants in order to solve them.

Results: Data shows how different ideas of good care [3] are practiced, intersecting different cultural, professional or contextual values, and articulate new opportunities for caring. To illustrate this, I will focus on apparently evident practices like eating activities, which originate different hospital repertoires: asylum; rehabilitation unit; home; leisure setting. If the therapeutic importance given to eating activities may overcome initial expectations, they may also be reconducted into a ludic dimension, for many opposite to the idea of caring.

Discussion and conclusions: Grand societal explanations on mental illness collide and co-habit, in everyday life, with how actors appropriate of practices, different circumstances for action are created, or diverse positions and motivations towards food, wellbeing and illness coexist. These sometimes hinder training skills for everyday activities, but facilitate sociability/solidarity among participants. Hence, these versions of good create not only different ways of caring, but different settings, within the hospital, that are seldom depicted in official discourses, and which are urgent to know and debate for the success and quality of mental illness policies.

Acknowledgements

The author acknowledges funding from from the Portuguese Foundation for Science and Technology (Fundação para a Ciência e Tecnologia), Grant ref. SFRH/BD/85712/2012. She also addresses special thanks to all the people in the field, who generously shared their experiences with mental illness.