Zorgvermijding en zorgverlamming: Naar een praktijk theorie voor de openbare geestelijke gezondheidszorg

The aim of this article is to understand the dynamics that bring forth the production and reduction of care avoidance and care paralysis. Care avoidance and care paralysis not only coincide, they reinforce and recall each other. Sometimes care workers however produce situations in which these phenomena are pushed back, situations in which trust and initiative – the opposite of care avoidance and care paralysis – appear. Pushing back care avoidance and care paralysis is linked to a style of work: establishing contact from a starting point of acceptance; looking for opportunities for affirmation; marking (small) progress. Care avoidance and care paralysis cannot thrive under conditions as: the proximity between the local population and care facilities; the committed involvement of professionals to a fixed territory; a network wherein signals (of nuisance or deprivation) and actions can be linked; discretional space for professionals to develop initiatives; a small-scale service level so that key figures from the local population and professionals of the care facilities can axially know each other; and finally a moral framework where indifference is brought up for discussion.