Structural disavowal and personal inundation of responsibility - a local perspective on pressure on mental health front-line professionalsStrukturell ansvarsfraskrivelse og individuell ansvarsoversvømmelse - kommunalt perspektiv på dilemmaer i profesjonelt arbeidet med rus og psykisk helse

• Published in: European journal of social work Vol. 25; no. 3; pp. 406 - 417
• Main Authors: Bjørkquist, Catharina, Ramsdal, Helge
• Format: Journal Article
• Language: English
• Published: Oxford Routledge 04-05-2022; Taylor & Francis Ltd
• Subjects: Addictions; Codes of conduct; Decentralization; Discretion; front-line professionals; health and social work; Medical personnel; Mental disorders; Mental health; Mental health services; organisation of services; organisering av tjenester; Policy implementation; Primary care; profesjonelle i førstelinje; Professionals; psykisk helse helse; Responsibility; Sexual deviance; skjønn; Social work; sosialt arbeid; Specialized services
• ISSN: 1369-1457; 1468-2664
• DOI: 10.1080/13691457.2021.1882399

This article examines how professionals in front-line mental health and addiction services respond to the dilemmas of implementing policies at the local level of the service system. In their daily work, front-line health and social work professionals must find ways to cope with challenges balancing limited resources, professional ethical standards and client needs for varied and flexible services. Front-line professionals have significant space for discretion in finding ways to cope with these dilemmas. We discuss these ways as a drift towards moral dispositions. Drawing on qualitative interviews with local managers and professionals, we find that front-line professionals find themselves at the bottom of the service line where one cannot 'decentralise' responsibilities any more. We describe and denote this as 'structural disavowal of responsibility', as patients with severe mental health diagnoses are often discharged from specialist services to primary care that lacks the necessary resources. Furthermore, front-line professionals improvise by including measures found in the local community and even their private lives, making their work exceedingly stressful. This is denoted 'personal inundation of responsibility'. We argue that the moral disposition of front-line professionals hence should be extended to encompass personal inundation as one perversion of their responsibilities.