Remaking “Community” Mental Health: Contested Institutional Logics and Organizational Change

Abstract

ABSTRACTNeo-institutional studies of institutional entrepreneurship identify the important role that individuals play as drivers of institutional change. Institutional entrepreneurs leverage resources to create new institutions or to transform existing ones. Recent scholarship complicates the depiction of institutional entrepreneurship as merely creative, examining its disruptive effects on established logics and practices. This article uses ethnographic methods to investigate how institutional entrepreneurship functioned in one community mental health organization, and extends neo-institutional theory by demonstrating how street-level workers contested its advancement. It theorizes the entrepreneurial nature of Quality Assurance (QA) staff, who promoted the managerial logic and developed performance measures to recouple frontline practice to public demands for efficiency, standardization, and accountability. Street-level workers used the community logic of the clubhouse to order their therapeutic identities, strategies, and goals. When these competing logics came into contact, multiplicity produced deep contradiction, epistemic distress, and ongoing struggle. This article finds that new managerialism forced a reworking of the community logic, and weighs the implications of this transformation for human services rooted in the community logic.