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Crustative care is a model of care developed for people with severe and persistent mental illnesses (SPMI). In this article, we will present the crustative care model and illustrate it with a case study. The model incorporates elements of the recovery approach and of palliative philosophy. Owing to their vulnerability, the care of people with SPMI poses many ethical challenges: advocating a holistic approach to the human person; seeking a balance between autonomy, care and protection; assessing decision-making capacity; pursuing shared decision-making; seeking equitable and sustainable allocation of resources; organising moral deliberation; and adopting ethical virtues.