Different Professional Ideal Types in the Inter-sectoral Management of Psychiatric Healthcare Trajectories

Abstract

Aim: To investigate how differences in types of professions and rationalities affect the management of inter-sectoral trajectories in psychiatric health care in the Capital Region of Denmark.
 Background: Some psychiatry users experience a lack of coherence between the mental health care treatment provided at hospitals and run by the regions, and that provided at residential psychiatric units run by municipalities. The literature points to various challenges in this field of research, related to transitions that need rethinking and further examination.
 Method: The approach is an eclectic use of theory and methods in a theory-governed analysis of empirical data built up from focus group interviews with professionals in mental health care centres and social psychiatric residencies. We classify the positions from the data using a theoretical framework based on Max Weber's theory of ideal types and from Pierre Bourdieu's concept of habitus. Our analysis outlines a theory about the practice of transitions in inter-sectoral trajectories in psychiatric health care. 
 Results: From the empirical material, we were able to construct different professional ideal types related to mental health care psychiatry and social psychiatry. The construction points to differences in the habitual basis of action that maintains institutional distinctions.
 Discussion: Differences in ideal types are connected to the prevailing positions of the two sectors, in which management in health care centres follows a dominant medical rationality, and management in residencies draws on a social and social educational legitimacy.
 Conclusion: We find differences between the rationalities and habitus of staff at regional hospitals and municipal residencies that enable us to explain how management contributes to trajectories in psychiatric health care. Choices concerning trajectory transitions relate to a combination of habitual professional inclinations and the management of trajectories streamlined through illness classification based on a neoliberal governance model. Future management must be aware of the different rationalities linked to professional and institutional logics when planning; and this requires reflexivity and awareness of the management of intersectoral collaboration.

Experiences and challenges faced by community mental health workers when providing care to people with mental health conditions: A qualitative descriptive study

“…Furthermore, apart from the hospitals, the CMHWs in this study reported better collaboration with fellow community partners, as both of them adopted similar treatment approaches and placed greater importance on social elements such as the PMHCs’ rehabilitation into the community (Frederiksen et al . 2020).…”

Recovery-Oriented Cross-Sectoral Network Meetings between Mental Health Hospital Professionals and Community Mental Health Professionals: A Critical Discourse Analysis

“…This approach is closely tied to the democratisation of discourse whereby professionals and users meet equally and respectfully. Democratisation has been a real force in modern medicine, and even though debate continues around cases where inequality and bigotry are still flagrant, the level and salience of the debate itself indicates that such issues are on the agenda [ 2 , 9 , 11 , 15 ]. Democratisation and dialogical discourses are not just methods but also interpersonal ways of meeting each other.…”

“…The professionals lack methods to work in a recovery-oriented way and to ensure coherence in efforts across psychiatric and municipal sectors [ 5 ]. Various initiatives are taken in mental health services across the sectors to promote a more recovery-oriented practice and cross-sectoral collaboration, e.g., implement open dialogue [ 6 ], flexible assertive community treatment [ 7 ], more focus on personal recovery [ 8 , 9 ], and cross-sectoral network meetings [ 10 , 11 ].…”

User Involvement in the Handover between Mental Health Hospitals and Community Mental Health: A Critical Discourse Analysis

“…Governmentality reflects this practice where language is associated with technical tools, practices and institutions aimed at shaping and reshaping behavior [ 35 ]. As other studies show, the user is, however, not sufficiently involved [ 1 , 6 , 18 ] and finds that the professional paternalistic discourse deprives them of the right to influence [ 4 , 18 , 25 ]. Users’ expert knowledge is downplayed and not included in the rational language of professionals, which elevates medical knowledge, evidence and selected legislative paragraphs as steering tools.…”

“…In several Western countries and regions such as the USA, Australia, the United Kingdom and Scandinavia, user involvement has been a milestone in the health sector. Health professionals must involve users in healthcare across mental health hospitals and community mental healthcare [ 1 , 2 ]. The Health Act in Denmark emphasizes that the patient’s right to self-determination must be respected [ 3 , 4 ].…”