ABSTRACT

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.

摘要

本文探讨了一线心理健康和成瘾服务的专业人员如何应对在服务系统的地方层面实施政策的困境。在日常工作中，一线卫生和社会工作专业人员必须设法应对挑战，平衡有限的资源、职业道德标准和客户对多样化和灵活服务的需求。一线专业人士在寻找应对这些困境的方法方面有很大的自由裁量空间。我们将这些方式讨论为朝着道德倾向的方向发展。通过对当地经理和专业人士的定性访谈，我们发现一线专业人士发现自己处于服务线的最底层，无法再“分散”职责。我们将此描述并表示为“结构性否认责任”，因为患有严重精神健康诊断的患者通常会从专科服务机构出院，转入缺乏必要资源的初级保健机构。此外，一线专业人士通过在当地社区甚至他们的私人生活中发现的措施即兴发挥，使他们的工作压力极大。这被称为“个人责任泛滥”。我们认为，一线专业人士的道德性格因此应该扩大到包括个人泛滥作为他们职责的一种变态。一线专业人士即兴发挥，包括在当地社区甚至他们的私人生活中发现的措施，使他们的工作压力极大。这被称为“个人责任泛滥”。我们认为，一线专业人士的道德性格因此应该扩大到包括个人泛滥作为他们职责的一种变态。一线专业人士即兴发挥，包括在当地社区甚至他们的私人生活中发现的措施，使他们的工作压力极大。这被称为“个人责任泛滥”。我们认为，一线专业人士的道德性格因此应该扩大到包括个人泛滥作为他们职责的一种变态。