Paper short abstract:

We use ethnographic material from a project that curates dialogue between the various players in mental healthcare to unpick the impact of accountability, charting its role in promoting some aspects of caring at the expense of others.

Paper long abstract:

There is something interesting, if possibly reckless, about critiquing cultures of accountability in contexts such as psychiatric services where a lack of accountability may (just may) make the difference between life and death, harm and preservation from harm. Or so the trope goes.

Re:Create Psychiatry is a project that seeks to reform mental healthcare through dialogue. It did not set out to critique regimes of accountability. In fact, though aware from the outset of the figure of the NHS bureaucrat, it elected to abstract it from its conversations, focusing instead on the patient - clinician relationality, and overcoming the problem of patients and clinicians feeling unseen and unheard.

But … in sidestepping the shadowy figure of the bureaucrat, and carving out a non-transactional space where the various players in mental healthcare can come together to talk and listen as attentive equals, Re:Create found itself engaging with accountability. This is because as well as making the difference between life and death, accountability makes it difficult to talk. Accountability may be central to some aspects of caring, such as linking decisions to evidence, but it appears inimical to other aspects, such as being present, splitting open Maria Puig de la Bellacasa’s tryptic of care as labour, affect and ethics. This paper presents an ethnographic account of the work of Re:Create Psychiatry, using it to investigate how accountability in mental healthcare impacts on relationality, care, trust and the possibility of open heartedness.