Title:
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Organisational dynamics of mental health teams
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This study explored the extent to which contextual differences affected the
organisational dynamics of mental health teams. Organisational dynamics in
mental health teams were explored by studying teams with similar primary tasks
who worked in differing contexts.
A psychodynamic methodology for exploring organisational dynamics was used to
explain the operation of mental health teams in terms of psychodynamic theory.
Five case studies were conducted in mental health services that were differentiated
by their proximity to patients and to the organisation. They were also differentiated
by specific differences in patients' level of illness, experience of staff and the
facilities provided to do the work. This enabled organisational. dynamics to be
related to structural elements of mental health service design.
The design of mental health services, for people with severe mental illnesses, has
grown to reflect other parts of the health service in terms of service structures
whilst the behaviours of staff reflects the psychological difficulties their patients
face. Patients experience disturbed intrapsychic boundaries that entail splitting off
and projecting of aspects of their ego to the extent that internal processes are
experienced as external. Staff split off madness or failure and locate it in the
patient so that both groups are caught in a hostile stand off.
Organisational defences were enacted in different ways in different parts of the
service. The ward offered a high action environment where newly trained staff
could feel effective through the administration of medication that was forced if
necessary. Staff retreated to the office and their experience was compared to being
in a city under siege. The specialist department offered staff more control over
their exposure to patients to the extent that very few patients were seen and service
ideals went unchallenged. The hostel faced staff with the boredom that results
from working with people whose condition goes unchanged over long periods of
time. In this environment staff took over daily rituals in place of the residents. The
community mental health team were responsible for the wellbeing of their patients
although they saw them only for brief periods. They ventured out into
unpredictable environments to administer their care.
The final case involved a primary care team and this case was used in the
consideration of potential effectiveness of new mental health service designs. It
was concluded that, without consideration of the impact of changes to service
structures on the unconscious processes of the staff, seemingly rational structural
changes could have unintended negative consequences on organisational dynamics
and therefore on the treatment that patients receive.
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