The praxis of mental health care and the manifestation of stigma: an ethnographic study in mental health centers in the Biobío Region, Chile

In this article, we inquire into how mental health praxis reproduces stigma toward users of mental health centers in the Biobío Region of Chile, focusing on the relational space of interactions where stigma is expressed and sustained. Based on a qualitative research design with an ethnographic approach, from June to September 2018 we conducted participant observation in both formal and informal contexts of health services, as well as ethnographic and semi-structured interviews. We identified a persistent tension between the community mental health model promoted by public health policies and biomedical approaches to the care of users with psychiatric diagnoses. These tensions shape the daily practice of health personnel and, consequently, the type of interventions that users receive in their interactions and participation within health services. They manifest in at least two dimensions: first, in the predominance of the biomedical model over other medical practices, which impacts and constrains the exercise of professional roles; and second, in the working conditions faced by mental health professionals, which lead them to experience burnout. We argue that both dimensions, in their interrelation, influence trajectories of mental health care and contribute to the reproduction of stigma toward people living with mental health conditions.