Paper short abstract:

Clinicians caught at the intersection of a rationalised healthcare economy and a moral imperative to recondition psychiatric crisis care develop a daily practice in which the therapeutic rejection of short-term valuing opens novel possibilities for morally tenable care under neoliberal conditions.

Paper long abstract:

The difficulty of predicting psychiatric crisis, anticipating its duration, and planning for its recurrence has been a moral and economic challenge for clinicians, families, and insurance providers for decades. Many progressive interventions for psychiatric crisis recognise that these experiences are social, the temporality of their emergence unknowable, and the trajectory of their development uncertain. But while some clinicians advocate for creative means of working with these complex histories and elusive futures, health care economies are generally less flexible, revealing how ostensibly shared goals are derailed by divergent values in practice. Based on fieldwork with clinicians in Berlin, Germany, this paper explores how local economies of care splinter around temporal horizons tethered to long- and short-term valuation. While health insurers understand psychiatric crisis as an imminent risk to be managed, and, when it occurs, met quickly with discrete interventions based on cost-effective measures, this clinical team takes a longer view, in which crisis is understood to be part of a recovery process that is not always measurable, or predictable, in economic terms. Insurers and clinicians both want to see patients avoid long and costly hospital stays, but they assess the relative risk of crisis episodes, and what past crises mean for future possibilities, according to different speculative frames. Caught at the intersection of a rationalised healthcare economy and a moral imperative to recondition crisis care, these clinicians develop a daily practice in which the therapeutic rejection of short-term valuing opens novel possibilities for morally tenable care under neoliberal conditions.