Paper short abstract:

The paper explores tensions between care and control in the community-based psychiatric care under the reform of psychiatry. It shows the importance of human connection allowed in the community setting and the need for continuous ethical consideration if control is not to take over.

Paper long abstract:

The ongoing reform of psychiatry in the Czech Republic introduced mental health centres as a new form of mental healthcare intended to provide treatment mainly outside institutions. One of the reform's aims is to "humanize" psychiatric care, in the system still largely based on big inpatient facilities, criticized by both users/survivors and professionals for violent or even inhuman conditions. Based on the ethnographic research in a new facility, where I worked as a psychologist in the past, the paper explores dynamics of caring and controlling. Assuming they may be both present in any form of psychiatric practice, I intended to investigate what sort of care is taking place in new services and how it interacts with control (and surveillance). Based on the experience of nurses who moved from inpatient to community-based setting, I will show the potential for developing a different kind of relationships to clients in the community. Analyzing several situations from centre's practice, involving practitioners of various professional background, I will show the urgent need for ethical consideration of every step taken by the centre towards clients as the centre's controlling role can easily take over. However, the need for reflection is not always recognized by practitioners. Person in a client role is often seen as not responsible for themself at the moment while practitioners adopt an either-or attitude towards responsibility. I will suggest that aplying rather a both-and attitude brings the space for dialogue that invites reflection and opens much broader field of possible actions.