Though the rationalisation of health care has been well documented, less is known about its impacts on mental health social workers. Drawing on qualitative data collected from 120 interviews and the qualitative comments on a Canadian four-province survey, the article explores the shifting labour process through profession-linked and organisational care strategies. The article argues that power is shifted from mental health social workers to management through stratagems including managerialism, biomedical hegemony and team-based care. These processes are complex and dynamic, travelling along professional divisions and logics, appearing neutral and scientific rather than as conduits reinforcing neoliberalised approaches to health care provision. Social workers’ resistance to these models of care is similarly complex and professionally based, though with strong elements of gendered altruism and social justice themes. Though this article draws on Canadian data, the analysis is likely highly applicable to other managerialised contexts including the UK. The article contributes to the intersection of Labour Process Theory and moral economy theory by highlighting the operation of a unique form of engagement referred to here as resistance-as-engagement. Overall, mental health social workers revealed strong oppositional narratives and identities pivoting on their marginalised position within team-based care, medical professional hierarchies and narrow, neoliberal approaches.

中文翻译：

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专业护理中不断变化的劳动流程：重新创造主导地位和管理化的心理健康社会工作者

尽管医疗保健的合理化已有充分记录，但对其对心理健康社会工作者的影响却知之甚少。本文利用从 120 次访谈中收集的定性数据以及对加拿大四省调查的定性评论，探讨了通过与职业相关的组织护理策略来改变劳动力过程。文章认为，通过管理主义、生物医学霸权和团队护理等策略，权力从心理健康社会工作者转移到了管理层。这些过程复杂而动态，沿着专业分工和逻辑进行，显得中立和科学，而不是作为加强新自由主义医疗保健提供方法的渠道。社会工作者对这些护理模式的抵制同样复杂且基于专业，尽管具有强烈的性别利他主义和社会正义主题元素。尽管本文借鉴了加拿大的数据，但该分析可能非常适用于包括英国在内的其他管理环境。本文通过强调一种独特的参与形式（这里称为“参与即抵抗”）的运作，为劳动过程理论和道德经济理论的交叉做出了贡献。总体而言，心理健康社会工作者在基于团队的护理、医疗专业等级制度和狭隘的新自由主义方法中处于边缘地位，揭示了强烈的对立叙事和身份。本文通过强调一种独特的参与形式（这里称为“参与即抵抗”）的运作，为劳动过程理论和道德经济理论的交叉做出了贡献。总体而言，心理健康社会工作者在基于团队的护理、医疗专业等级制度和狭隘的新自由主义方法中处于边缘地位，揭示了强烈的对立叙事和身份。本文通过强调一种独特的参与形式（这里称为“参与即抵抗”）的运作，为劳动过程理论和道德经济理论的交叉做出了贡献。总体而言，心理健康社会工作者在基于团队的护理、医疗专业等级制度和狭隘的新自由主义方法中处于边缘地位，揭示了强烈的对立叙事和身份。