Mobilising clinical health care: a qualitative-ethnographic pilot study about health care practices in psychiatric home treatment

• Applicant: Dr. Milena Bister
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Social and Cultural Anthropology and Ethnology
• Term: from 2013 to 2015
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 232279595

This project examines the everyday working practices of professionals and patients during the introduction of home treatment (HT) as part of clinical psychiatric care, and as such is at the intersection between Health Services Research and Medical Anthropology. HT is a mental health care service for patients with acute psychiatric illness that is provided in their homes by a multidisciplinary team. In this project, I align mental health services with medical anthropology by performing an ethnographic analysis to empirically understand the transition from more traditional mental health services to the HT method. This study will also expand our understanding of the role that knowledge, expertise and materiality play in the concomitant changes of the patients' everyday lives and the professionals' routines. The project focuses on the implementation of HT as a multifaceted mobilisation of clinical health care: First, professionals must leave the clinical space and move into the life-world (Lebenswelt) of the patients. This practice impacts the working routines of the professionals and the organisation of the clinic equally. Furthermore, leaving the clinic requires a change of professional treatment practices, such that professionals must adapt their practices to treat the patients while simultaneously incorporating them and their social networks in novel ways that involve a highly autonomous mobile intervention team. At the same time, patients (and their networks) must prepare their homes accordingly. Finally, a material infrastructure must be maintained that allows similar levels of observation, documentation and evaluation to those experienced with more traditional treatment methods.Fieldwork will occur at a psychiatric clinic in a rural, economically underdeveloped area in Germany. A stepwise transition to the HT method, in accordance with the principles of the Scandinavian open dialogue approach, is scheduled to occur in October 2012. A qualitative-ethnographic study of this transition process should expand our knowledge about the anthropological impacts of these types of changes, and also provide evidence about everyday practices of innovative psychiatric health services.

• DFG Programme: Research Grants