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.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:488405 |
| Date | January 2002 |
| Creators | Hyde, Paula |
| Publisher | University of Manchester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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