Understanding How Case Managers Use 'Sabotage' as a Frame for Clinically Difficult Situations.

Case managers are among the direct service providers responsible for engaging people with severe mental illnesses. Understanding how they interpret and respond to clinically difficult situations can inform ways to intervene and reduce service disengagement. This qualitative study explored clinically difficult situations when case managers invoked the term "sabotage". Interviews were conducted with 21 case managers and analyzed by co-coders focusing on how case managers used the term sabotage to describe service user behavior. Themes that emerged were attributing sabotage to; fear of success, fear of attaining what you desire, avoidance of responsibility and change, and a lack of structured support. Drawing on the concepts of clinical case management and mental health recovery, we consider implications for the training and supervision of case managers and how services are structured.