Self-casting and alter-casting: Healthcare professionals’ boundary work in response to peer workers

Abstract

Within mental health services, the recovery model has been a guiding philosophy over the past decades. This model stresses ‘person-centred care’ and focuses on assisting service users to live a meaningful and hopeful life even if their illness has not been cured. As part of the recovery orientation, ‘peer workers’ (PWs), i.e. people with lived experiences of mental illness, are increasingly employed within mental health services. In this article, the authors explore how these changes open up frontiers and set in motion boundary work and identity discussions among healthcare professionals. Empirically, the article draws on qualitative data – interviews with healthcare professionals and observations of meetings – collected in mental healthcare services in Denmark. Theoretically, the article combines literature on professional boundary work with theories on ‘self-casting’, ‘alter-casting’ and ‘othering’. Analysing two sets of demarcations – those between healthcare professionals and PWs, and those between professionals and patients – the study shows how the recovery model leads to defensive boundary work as well as an opening up of boundaries.