An incongruous duality?: Care, control & the social world of the mental health worker

Abstract

The contemporary mental health profession is facing a crisis of recruitment and retention. Services provided are complex, practically and conceptually. On one hand, assessments and treatments are provided, but on the other, staff become responsible for the administration of coercive security discourses and arrangements. This complex phenomenon can leave mental health personnel vulnerable to criticisms in exactly how best they should discharge their duties within an occupational remit of duality. Working in the correct or most appropriate way is a constant challenge for staff as they must meet with approval from both managers and colleagues negotiating a path between formal rules and informal norms. This exploratory study was undertaken within a mental health NHS Trust in the North of England. It interviewed twenty participants from a range of areas of work, namely hospital wards, occupational therapy departments and the community setting. A narrative interviewing technique has been used to collect occupational histories and stories which have been used in an attempt to illuminate the contemporary issues facing clinical staff. Findings suggest that their contemporary care delivery is much more complex than previously known and that there is a diverse range of background and conceptual challenges which workers face in addition to their organisationally prescribed practical mandates of work. Six normative orders of work have emerged from data that has been collected; bureaucracy, risk management, competence, morality, physical environment and care versus control. Participant reflections on professional autonomy and responsibility shed light on the perceived rationality of policies and procedures and 'governance at a distance' taking place in response to bureaucratic and risk reduction imperatives. Indeed, such work is demanding and the management of a professional 'performance', and the self regulating and adaption of emotion have been seen to be an important dimension in the observation of occupational competence and work-based socialisation processes. Furthermore, personnel are engaged in a complex and fluid role duality where they must personally reconcile their role as care provider whilst also maintaining levels of physical security in a contemporary and technologically advanced healthcare environment. In this thesis, it is argued that these normative aspects of work typify the social nature of mental health work and, in addition, take place under the auspices of Goffmanesque theorisations of the 'total institution', 'mortification of self and 'social contamination'. These findings draw particular attention to an under acknowledged aspect of mental health based inquiry where the formal and informal spheres of work are observed to co-mingle within the environment of psychiatry. In doing so, questions arise over the rationality of some systems of work which 'shop-floor' staff are engaged within, yet, at times, have very little opportunity to shape as individual practitioners.