Moral Decision-Making among Assertive Community Treatment (ACT) Case Managers: A Focus Group Study

Lerbæk, Birgitte; Aagaard, Jørgen; Andersen, Mette Brændstrup; Buus, Niels

doi:10.3109/01612840.2015.1022843

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Interestingly, a prior study found that patients subject to CTOs in Norwegian ACT teams were more satisfied than patients without CTOs [ 58 ]. Our respondents’ overall positive view of ACT stands in contrast to some other studies describing concerns relating to paternalism, rights to privacy and self-determination and human rights [ 59 – 61 ].…”

Section: Discussioncontrasting

confidence: 96%

Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders

Stuen

Landheim

Rugkåsa

et al. 2018

BMC Health Serv Res

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BackgroundPatients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting.MethodsThe study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data.ResultsThe main theme ‘responsibility with conflicting priorities’ emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs.ConclusionsMany of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3097-7) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 96%

Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders

Stuen

Landheim

Rugkåsa

et al. 2018

BMC Health Serv Res

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“…ACT case managers’ everyday work takes place in a less predictable healthcare setting compared to work in traditional psychiatric hospital wards and office‐based outreach services. This requires them to work with high levels of initiative and independent decision‐making (Lerbæk et al ; Williamson ).…”

Section: Introductionmentioning

confidence: 99%

Assertive community treatment (ACT) case managers’ professional identities: A focus group study

Lerbæk

Aagaard

Andersen

et al. 2016

Int J Mental Health Nurs

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Assertive community treatment (ACT) case managers provide healthcare services to people with severe and persistent mental illness. These case managers take on generic roles in multidisciplinary teams and provide all-around services in the clients' private homes. This focus group study aimed to gain insight into Danish ACT case managers' professional identity work by examining their discussions of ethical dilemmas and collaboration in their everyday practice. Data were collected during five focus groups at three ACT teams in the North Denmark Region and subjected to discourse analysis emphasizing how identity work was accomplished through talk. The findings indicated that the case managers constructed professional identities by actively positioning themselves and the particular ACT approach in relation to other mental healthcare professionals and clients. They represented themselves as achieving better client-related outcomes by being more assertive and persistent, and as responsible caregivers who provided the help that their clients needed when other services had failed to do so. They depicted their services as being focused on the clients' well-being, and their persistent efforts to establish and sustain interpersonal relationships with clients were an important part of their service. Basic nursing tasks were described as an important part of their everyday work, and even though such tasks were not distinctive for ACT case managers, the representations of their work seemed to give them a sense of worth as professionals and legitimized a unique role in the community mental healthcare services.

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“…Previous research has described how management of physical health issues in the context of some mental health services entails dilemmas, which might lead to MHCPs resorting to deviant practices, such as bending clinical guidelines and omitting certain tasks, in order to safeguard fragile relationships with mental health service users [ 19 , 20 ]. Different factors can lead to such deviant practices.…”

Section: Discussionmentioning

confidence: 99%

“…This duality promotes siloed organisational structures in health care and fragmentation of services across healthcare systems [ 18 ], which create barriers to the promotion of physical health, detection and treatment of coexisting mental and physical illnesses. Consequently, in some mental health care settings the management of physical health issues is marginalised as a strategy to safeguard tenuous clinical relationships or to manage dilemmas embedded in health promoting activities [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“It’s Not Important”—The Social Constructing of Poor Physical Health as ‘Normal’ among People with Schizophrenia: Integrated Findings from an Ethnographic Study

Lerbæk

Jørgensen

McCloughen

2023

IJERPH

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People with schizophrenia have shortened life expectancy partly due to physical ill health. Management of coexisting mental and physical health issues is complex, and knowledge in the field is lacking. This study investigated how physical health was managed among people with schizophrenia, by integrating findings from three separate analyses conducted in an ethnographic study. Qualitative data generation methods were used; 505 h of field work were undertaken among nine participants with schizophrenia and 27 mental healthcare professionals were interviewed using a semi-structured interview approach. Three separate analyses were conducted using thematic and discourse analysis. Progressive focusing was used to integrate findings. Across the mental health care contexts that were part of this research, managing physical health was characterised by a lack of recognition of the seriousness of physical health issues as part of everyday life among people with schizophrenia. Poor physical health was accounted for as being “not of importance” by both mental health care professionals and the participants experiencing physical health issues. The integrated findings offer new insights about the social co-construction of poor physical health as something normal. At the individual level, this shared understanding by people with schizophrenia and healthcare professionals contributed to sustaining inexpedient management strategies of “modifying” behaviour or “retreating” from everyday life when physical health issues were experienced.

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Moral Decision-Making among Assertive Community Treatment (ACT) Case Managers: A Focus Group Study

Cited by 7 publications

References 22 publications

Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders

Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders

Assertive community treatment (ACT) case managers’ professional identities: A focus group study

“It’s Not Important”—The Social Constructing of Poor Physical Health as ‘Normal’ among People with Schizophrenia: Integrated Findings from an Ethnographic Study

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