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Opening the Gift: Social Inclusion, Professional Codes and Gift-Giving in Long-Term Mental Healthcare

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Abstract

Deinstitutionalisation has not only made the social inclusion of clients a key objective in long-term mental healthcare, it may also affect the role of the care professional. This article investigates whether the social inclusion objective clashes with other long-standing professional values, specifically when clients give gifts to care professionals. In making a typology of gifts, we compare the literature on gift-giving with professional codes for gifts and relate both to the objective of social inclusion of clients. Our typology draws on an analysis of ethnographic fieldwork carried out in 2007/2008 at a Dutch mental healthcare centre. We identify four types of gifts for professionals in long-term mental healthcare, each relating individually to professional codes and the objective of social inclusion of clients. Only the ‘personal gift’ directly supports social inclusion, by fostering personal relationships between professionals and clients. Acceptance of this type of gift is advocated only for long-term care professionals. We suggest that professional codes need to consider this typology of gifts, and we advocate promoting reflexivity as a means of accounting for professional behaviour in deinstitutionalised care settings.

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Notes

  1. The terms employed to refer to people using mental healthcare services are contested and politically laden with ideas about the practice of mental healthcare (McLean 1995). In the mental healthcare centre involved in this study, actors primarily use the term ‘client’ to refer to this group of people. Our use of ‘client’ in this article does not imply our personal stance in the debate, merely that we wish to stay close to the empirical material.

  2. That is, events that have simultaneous social, religious, magical, economic, utilitarian, sentimental, legal and moral significance (Lévi-Strauss 1976).

  3. The recommendations of the Ethics Committee of the American Psychiatric Association on the acceptance of large monetary gifts is a good example of such advice in the international context (APA 2001, p. 36–37).

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Acknowledgments

This research was supported by Grants from the VSB fonds, the kfHein fonds, and Mondriaan Zorggroep. We are grateful for the cooperation of the staff and clients of the mental healthcare centre, where the fieldwork for this article was conducted. In earlier versions, this article has been presented at several conferences and workshops. We wish to thank attendees of the Rotterdam EASST 2008 conference, the Lancaster 2009 PhD summer conference, and members of the PhD seminar of the Centre de Sociologie de l’Innovation in Paris for their advice and comments. In addition, we thank Bianca Bruinsma, Tineke Broer, Eline van Haastrecht, Lineke van Hal, Jean Philippe de Jong, Samuel Lézé, Annemarie Mol, Vololona Rabeharisoa and Lineke van Hal for discussing this article with us and for their feedback and suggestions.

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Authors and Affiliations

  1. Department of General Practice, Academic Medical Centre/University of Amsterdam, Medical Ethics Section, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands

    S. T. C. Ootes, A. J. Pols & D. L. Willems

  2. Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands

    E. H. Tonkens

Authors
  1. S. T. C. Ootes
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  2. A. J. Pols
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  3. E. H. Tonkens
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  4. D. L. Willems
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Correspondence to S. T. C. Ootes.

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Ootes, S.T.C., Pols, A.J., Tonkens, E.H. et al. Opening the Gift: Social Inclusion, Professional Codes and Gift-Giving in Long-Term Mental Healthcare. Cult Med Psychiatry 37, 131–147 (2013). https://doi.org/10.1007/s11013-012-9293-8

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  • DOI: https://doi.org/10.1007/s11013-012-9293-8

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