Visible and Invisible Care: An Anthropological Study of Nursing Assistants on a Psychiatric Ward in London

This thesis is based on ethnographic research carried out in a psychiatric hospital in London. It explores the ways in which mental health care is constructed and practiced by different sections of staff. Everyday psychiatric care functions through the management of contradictions between C, two different approaches. The first will be termed the official discourse of care created within professional domains such as Government, NHS and Trust policies. Fundamental to this is a desire for a patient-centred approach where care is 'therapeutic' and 'empowering'. This official discourse structures the ideology which nurses, psychiatrists and Trust management attempt to follow. The second approach here termed the unofficial approaches of care, turns the official discourse on its head. It is constructed by the unqualified sector of the psychiatric staff - the nursing Z-1 assistants (NAs). Typically, nursing assistants who enter into this low paid employment are not motivated by vocation, as the official discourse implies. They are positioned in, what I term, the organization's buffer zone: the meeting point of the official and unofficial. It is within this zone that the undesirable, but essential areas of care are carried out so that the official ideology of care prevails. While the unofficial domain primarily protects the nursing assistant, it also protects the qualified staff from acknowledging specific aspects of care on the ward. The dependency results in a 'trade-off' in which the role of the nursing assistant is made invisible. The specific focus of this thesis not only lends itself to broader debates on the role that contradictions play within psychiatry, but also how the concept of contradictions can develop the anthropology of organisations, policy and work