Different Professional Ideal Types in the Inter-sectoral Management of Psychiatric Healthcare Trajectories

Abstract

Aim: To investigate how differences in types of professions and rationalities affect the management of inter-sectoral trajectories in psychiatric health care in the Capital Region of Denmark. Background: Some psychiatry users experience a lack of coherence between the mental health care treatment provided at hospitals and run by the regions, and that provided at residential psychiatric units run by municipalities. The literature points to various challenges in this field of research, related to transitions that need rethinking and further examination. Method: The approach is an eclectic use of theory and methods in a theory-governed analysis of empirical data built up from focus group interviews with professionals in mental health care centres and social psychiatric residencies. We classify the positions from the data using a theoretical framework based on Max Weber's theory of ideal types and from Pierre Bourdieu's concept of habitus. Our analysis outlines a theory about the practice of transitions in inter-sectoral trajectories in psychiatric health care.  Results: From the empirical material, we were able to construct different professional ideal types related to mental health care psychiatry and social psychiatry. The construction points to differences in the habitual basis of action that maintains institutional distinctions. Discussion: Differences in ideal types are connected to the prevailing positions of the two sectors, in which management in health care centres follows a dominant medical rationality, and management in residencies draws on a social and social educational legitimacy. Conclusion: We find differences between the rationalities and habitus of staff at regional hospitals and municipal residencies that enable us to explain how management contributes to trajectories in psychiatric health care. Choices concerning trajectory transitions relate to a combination of habitual professional inclinations and the management of trajectories streamlined through illness classification based on a neoliberal governance model. Future management must be aware of the different rationalities linked to professional and institutional logics when planning; and this requires reflexivity and awareness of the management of intersectoral collaboration.