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多样性、复杂性和有序性:机构外精神卫生服务——服务使用者和专业人员基于经验的实践和知识,以及新公共管理。

Diversity, Complexity and Ordinality: Mental Health Services Outside the Institutions-Service Users' and Professionals' Experience-Based Practices and Knowledges, and New Public Management.

机构信息

Department of Mental Health, University of Agder, 4630 Kristiansand, Norway.

Department of Social Work, Stockholm University, 106 91 Stockholm, Sweden.

出版信息

Int J Environ Res Public Health. 2021 Jul 2;18(13):7075. doi: 10.3390/ijerph18137075.

Abstract

In conjunction with the dismantling of psychiatric hospitals, social workers have been commissioned to help service users in their daily living in their homes and in the community. The consequences of these changes for experience-based knowledge and practices in their contexts remain relatively unknown. In this study, eighteen service users and the social workers they described as helpful for them were interviewed. The interviews were recorded, transcribed, and analyzed using Thematic Analysis. The following themes emerged: "Here, there and everywhere", "Doing, being, becoming", "Talking" and "Order, planning and improvisation" concerning the contradictions service users and professionals mentioned about their practices and the conditions imposed by managerial methods connected to New Public Management. Finally, "Spontaneous planned complexity" was chosen as our overarching theme to characterize the new knowledge and practices which have been developed. The displacement of the place for the encounter and the introduction of non-medicalized professions have allowed community-based practices and thus the co-creation and emergence of new knowledge about the service users as persons and the professionals as qualified professionals. The challenge remains for managers to have trust in their colleagues and not impose rigid rules, schematized methods, and repeated controls.

摘要

随着精神病院的拆除,社会工作者受委托帮助服务使用者在其家中和社区中进行日常生活。这些变化对其背景下基于经验的知识和实践的影响尚不清楚。在这项研究中,对 18 名服务使用者和他们描述的对他们有帮助的社会工作者进行了采访。采访使用主题分析进行了记录、转录和分析。出现了以下主题:“无处不在”、“行动、存在、成为”、“交谈”和“秩序、规划和即兴创作”,涉及服务使用者和专业人员提到的关于他们的实践以及与新公共管理相关的管理方法所施加的条件之间的矛盾。最后,选择“自发计划的复杂性”作为我们的总体主题,以描述已经开发的新知识和实践。相遇地点的转移和非医疗化职业的引入允许基于社区的实践,从而共同创造和出现关于服务使用者作为个人和专业人员作为合格专业人员的新知识。管理者仍然面临的挑战是要相信他们的同事,而不是强加严格的规则、刻板的方法和重复的控制。

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