'No Dumping!' Threshold Work in Voluntary Sector Mental Healthcare in Inner-City London

This paper examines the sociomaterial dynamics of mental healthcare by following metaphors circulating among voluntary sector providers that they were becoming 'dumping grounds' within a system in crisis. In the United Kingdom, the voluntary sector has long been called upon to deliver flexible, community-based care that reduces pressure on primary and secondary services. Under chronic conditions of austerity, however, providers have been stretched beyond their capacity. Drawing on ethnographic research across three voluntary sector mental health sites in inner-city London, I analyse how providers made and maintained places of care while grappling with expanding and shifting demands. Taking a sociomaterial approach, I propose the analytic concept of 'threshold work' to complicate the dumping metaphor and to reconceptualise how material thresholds of place and immaterial thresholds of mental health need are co-constituted with care practices. I identify three interrelated modes of threshold work through which providers manage the limits of inclusion, revealing how diagnostic boundaries of need and spatial arrangements of care move together, shaping the terms and conditions of care in the city.