An ethnography of psychiatric home treatment

Abstract

This thesis is an ethnography of a South London psychiatric home treatment team (also called a crisis resolution and home treatment team) practicing within the context of government “austerity” policies that followed from the 2008 financial crisis. It draws on 15 months of ethnographic fieldwork, 40 interviews with service users and staff, over 200 home visits, and observations from many other formal and informal settings. Following an account of the history of home treatment teams and their entanglement with austerity, I explore the way in which the Home Treatment Team is being used by a mental health trust to manage mental health in conditions of austerity, which have increased the numbers of people seeking mental health treatment as well as pressure on in-patient beds, and reframed home treatment as a financially attractive alternative to hospitalisation. This has led to a restructuring of the work of the Home Treatment Team to contain increasing numbers of distressed individuals within a flexible framework. I show how this restructuring impacts particularly on those service users considered “difficult” and those who are not white. I examine the clashes between the “timescapes” of service users’ rhythms of life and the institutional timescapes required by home treatment. I place the work of Home Treatment Teams in the wider environment in which the Team operates, analysing this as a landscape of distress. This landscape includes the effects on mental health of the changes in welfare regimes, housing regeneration, and precarious living conditions as well as precarious work. In conclusion, I bring these different dimensions of Home Treatment together to show how home treatment teams have been reshaped in order to manage austerity, but also how the work of those teams can be a source of relief from the landscapes of distress that have been exacerbated by austerity.

Date of Award	1 Jul 2020
Original language	English
Awarding Institution	King's College London
Supervisor	Hanna Kienzler (Supervisor) & Nikolas Rose (Supervisor)