Responding to mental health crisis at a street level: mental health practitioners as street-level bureaucrats

Abstract

Street triage practitioners, consisting of mental health social workers and nurses, act as a conduit between service users and emergency services, and have a significant amount of discretion in determining the care and treatment pathways for individuals experiencing mental health crises. However, this is set against a backdrop of neoliberal reforms that have resulted in an increased focus on risk management, accountability, responsibilisation and managing scarce resources. Based on ethnographic research undertaken in a street triage setting in the UK, this article examines the role of street triage practitioners as ‘street-level bureaucrats’ and explores the impact of neoliberal mental health reforms on street-level practice and how these shape and constrain the use of discretion in a street triage context. Revisiting the relevance of Lipsky through a neoliberal lens, the article identifies how street triage practitioners use their discretion to navigate practice dilemmas in a contemporary mental health landscape.