Community Psychiatry as a Not-for-Profit Business: a Study of an Emerging Mental Health Centre

The article deals with the study of community psychiatry in the Czech Republic and aims to connect the historical and political context of the establishment of this discipline with the changes in its practice arising from the reform of the psychiatric care currently underway.Community psychiatry can be understood as psychiatry's attempt to maintain its position as the hegemon of social control through biological and psychological means in an era of rising neoliberal governments.In the Czech Republic, community psychiatry did not emerge as part of medicine but took shape as part of civic activism for the rights of people with psychiatric diagnoses, which took the form of non-governmental non-profit organisations that later provided social services.It is only with the reform that it is becoming part of medicine.The article is based on ethnographic research in one of the first mental health centres, a new type of psychiatric facility set up as part of the reform in collaboration between the public and non-profit sectors.The practices at the newly forming centre reveal that the neoliberal order is entering psychiatry, paradoxically, through the non-profit sector.The new services are funded based on the quantity of medical and social work interventions delivered by these services and recognised by the country's health insurance companies and local authorities administering the public budget for social services.The staff of the centre are required to carry out as many social work and medical interventions as possible in the shortest possible time frame with the least possible use of public resources.Work at the centre is thus characterised by a high demand for flexibility and pressure to perform.Service providers are forced to compete with each other for resources and have limited ability to reverse this situation.