Diversity, Complexity and Ordinality: Mental Health Services Outside the Institutions-Service Users' and Professionals' Experience-Based Practices and Knowledges, and New Public Management.

Alain Topor,David Matscheck

doi:10.3390/ijerph18137075

Abstract

In conjunction with the dismantling of psychiatric hospitals, social workers have been commissioned to help service users in their daily living in their homes and in the community. The consequences of these changes for experience-based knowledge and practices in their contexts remain relatively unknown. In this study, eighteen service users and the social workers they described as helpful for them were interviewed. The interviews were recorded, transcribed, and analyzed using Thematic Analysis. The following themes emerged: “Here, there and everywhere”, “Doing, being, becoming”, “Talking” and “Order, planning and improvisation” concerning the contradictions service users and professionals mentioned about their practices and the conditions imposed by managerial methods connected to New Public Management. Finally, “Spontaneous planned complexity” was chosen as our overarching theme to characterize the new knowledge and practices which have been developed. The displacement of the place for the encounter and the introduction of non-medicalized professions have allowed community-based practices and thus the co-creation and emergence of new knowledge about the service users as persons and the professionals as qualified professionals. The challenge remains for managers to have trust in their colleagues and not impose rigid rules, schematized methods, and repeated controls.

Highlights

In the Nordic countries, the overall aim of the dismantling of the mental hospitals was normalization
We argue that the continuing trend towards standardization in accordance with the principles of New Public Management (NPM) threatens the use of experience-based knowledge, as is indicated by the official stance that there is a lack of evidence for the effectiveness of home-based interventions such as support in daily living” (SIDL)
This study highlights basic aspects of helpful home social work, such as spontaneous planned complexity and diversity ordinality based on mutuality and reciprocity, which support processes of being and becoming and recovery for the service user

Summary

Introduction

In the Nordic countries, the overall aim of the dismantling of the mental hospitals was normalization It was not the patients and service users who were to become “normal”, but rather their living conditions [1]: people should have their own apartments, a basic income and possibilities to participate in various social activities. As it was the responsibility of the welfare state to secure acceptable housing, economic conditions and health care for all citizens, persons with mental health problems were included in the social service’s mission, separate from psychiatric services whose aim it is to concentrate on medical and psychotherapeutic interventions. Psychiatric service remained exclusively part of the health care sector, organized on a regional basis and concentrating on a medical treatment model, while social services became the responsibility of local authorities and included provision of acceptable housing, economic resources, and daytime activity centers [2]

Objectives

Methods

Results

Discussion

Conclusion