Giving a fig about roles: policy, context and work in community mental health care

Abstract

Across the UK, mental health professionals are strongly objecting to threats to their roles. Against this background we use ethnographic data from a study of roles and responsibilities in community care, undertaken across two contrasting sites in Wales, to demonstrate how work is sensitive to local organizational features and to show how gaps can grow between the public claims professions make about their contributions and the actual roles which their members fulfil in the workplace. We reveal how, in one of our two research sites, immediate contextual features shaped the work of nurses and social workers towards the fulfilment of expanded packages of activity. We then show how subsequent policy (including 'new ways of working'), combined with new pressures arising from the economic downturn, carry the potential to accelerate the wider creation of workplaces of this type. We examine some implications of these processes for nurses and others, and for the system of mental health care as a whole, and conclude with a call for closer attention to be paid to the potential, wider, impact of current developments.