Uncertainty in mental health care: An analysis of decision-making in psychiatric emergency departments

How do caregivers in psychiatric emergency departments, whose job is to calm crisis situations and then guide the patient toward structures providing the necessary care or support, determine on a daily basis "what should be done"? This article, based on observations made in a Brussels hospital, seeks to understand what types of issues and constraints underlie the daily practice of caregivers and how the different actors relate to each other. It shows how the daily work of caregivers in psychiatric emergency departments is underpinned by a tension between the uncertainty inherent in care work, reinforced here by the particular status of the patient's words, and high and sometimes conflicting expectations on the part of patients, their relatives, care institutions, and public authorities. Taking into account these issues, it appears that the inquiry carried out by the caregivers and the resulting decisions are certainly based on medical grounds, but they must also meet pragmatic requirements such as cooperation with the patient and practical feasibility.