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Giving a fig about roles: policy, context and work in community mental health care
Author(s) -
HANNIGAN B.,
ALLEN D.
Publication year - 2011
Publication title -
journal of psychiatric and mental health nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 63
eISSN - 1365-2850
pISSN - 1351-0126
DOI - 10.1111/j.1365-2850.2010.01631.x
Subject(s) - mental health , context (archaeology) , public relations , government (linguistics) , work (physics) , ethnography , social work , health care , nursing , psychology , political science , sociology , medicine , psychiatry , geography , mechanical engineering , archaeology , anthropology , law , engineering , linguistics , philosophy
Accessible summary• In this paper we examine why some nurses, doctors and social workers in the UK are becoming increasingly worried that their contributions to the care of people with mental health problems are under threat. • We first use data from a study of roles and responsibilities in community mental health care, completed in two contrasting research sites in Wales, to show how the roles of nurses and other professionals are moulded by features of the local workplaces in which they are employed. This shaping of roles results in members of the same occupational group doing different types of work in different settings. We particularly show how, in the site we call ‘Midtown’, local features encouraged large overlaps in the work of community mental health nurses and social workers. • We then show how recent government policy is explicitly breaking down old assumptions about the work which professionals do, and is giving local NHS organizations a greater say in shaping the roles which professionals fulfil. • We examine how these policy processes, and new pressures arising from the economic downturn, are promoting the wider emergence of workplaces like the one we found in Midtown in which the roles of mental health professionals become increasingly blurred. We examine some of the implications of this, for professionals, service users and for the mental health system as a whole.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.