RESUMO
Effective case managers in community mental health are successful at forging a working alliance with recipients. This article explores one key aspect of case management practice, serving involuntary clients, specifically those on outpatient commitment orders. In 19 intensive interviews, a subset of a larger study, case managers shared their perceptions of the utility of outpatient commitment with a focus on how such orders impacted the professional relationship. We argue that the use of advance psychiatric directives and shared decision-making processes can reduce the need for coercive practice.
Assuntos
Assistência Ambulatorial/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Internação Compulsória de Doente Mental/normas , Internação Compulsória de Doente Mental/tendências , Tomada de Decisões , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Estados UnidosRESUMO
In community mental health, limitation of service recipient choice and freedom takes place through mechanisms ranging from subtle to blatant. The justification of coercion in these settings typically focuses on recipient deficits. We argue that this focus must shift to the service system itself, and that the most successful efforts to improve recipient engagement will be those that support respectful provider-recipient relationships and the delivery of services that help recipients achieve goals of their choosing.
Assuntos
Coerção , Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/reabilitação , Serviço Social/métodos , Humanos , Competência Mental , Preconceito , Isolamento Social , Violência , Populações VulneráveisRESUMO
Social workers have long been involved in developing, administering, and providing services for people with psychiatric disabilities. Critics of the system, including social workers and mental health consumer-survivor practitioners, have noted that the medical model has been a driving force in policy and services provision. This model is detrimental to consumers' self-efficacy and sense of hope and conflicts with a number of central social work values. The article argues that the values and beliefs of the consumer-survivor recovery movement are closely aligned with those of the profession, and that the movement offers social workers a more promising perspective from which to practice. The primary concepts and values of the evolving recovery paradigm are delineated, and implications for direct practice, administration, policy making, education, and research are discussed.