Queensland University of Technology, Brisbane, Queensland, Australia.
The University of Melbourne, Shepparton, Victoria, Australia.
Health Soc Care Community. 2022 Feb;30(2):519-528. doi: 10.1111/hsc.13152. Epub 2020 Sep 7.
This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n = 13) working at the service participated in semi-structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re-examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams-a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of working to become possibilities.
本文通过对澳大利亚农村地区一个多学科心理健康服务中心的案例研究,为年轻人心理健康支持的医学化研究做出了贡献。该服务中心的所有工作人员(n=13)都参与了半结构化的个人访谈。对访谈数据的文字记录进行了阅读,并根据参与者如何看待和体验向不同年轻人提供心理健康护理的总体问题进行了选择性编码和解释。在进行分析性反思后,使用医学化的概念重新检查了与参与、可及性和护理提供相关的代码,以了解心理健康护理的生物医学基础,以及这在参与者在回应不同年轻人的心理健康问题时所谈到的体验和感知挑战中是如何表现出来的。分析结果以五个主题标题呈现:(a)在服务提供中优先考虑临床专业知识和优先事项,这是一些参与者之间冲突的重要来源;(b)“多学科”团队——“有时是一种困难的文化”;(c)阐明文化障碍的所在之处;(d)年轻人被引导“参与”“心理健康”的轨迹;(e)空间的临床“感觉”。我们认为,需要对思考和处理心理健康以及护理提供的替代方法进行服务和系统投资,这些方法需要认识到并参与到个人情况与社会、地点、文化、经济和政治背景之间的内在联系。这对于农村地区的护理提供尤为重要,因为那里的服务选择有限,而且为生活在偏远环境中的不同年轻人提供护理的机会和提供护理的复杂性。需要制定跨学科框架,服务机构必须承认自己的文化立场,以便为其他工作方式提供可能性。