Interactions Between Institutional and Case- Specific Symbolic Objects

The interplay between case-specific and institutional objects provided valuable illustrations of how case-specific symbolic meanings reflected ways in which the AO team were obliged to carry out the institutionally defined tasks inherent in their role. This is illustrated once again by the ways in which High and Social Outings reflect particular meanings derived from institutional objectives, requirements and objectives that are placed upon the team.

High can be seen as a direct reflection of how the team understand the purpose of AO. As discussed previously, this meaning represented their view of an individual demonstrating unpredictable behaviour, posing a potential risk to themselves and others due to this unpredictability and viewed as becoming more difficult to engage. Consequently, what had developed over time was that the team had come to associate certain behaviours and actions with an individual being High. Their reasoning for doing so can be found in the meaning that has been constructed for one of the purposes of AO: preventing relapse. In this sense, the AO team interpreted a part of their role as that of identifying triggers and relapse signatures indicating to them that an individual is relapsing.

Similarly, this can also be seen with Social Outings. In the case of the client referred to earlier, a predominant feature of their early engagements with the team consisted of shopping trips. However, what is apparent is the way in which the meaning of Social Outings was constructed to represent a way of providing regular engagement and also security to the team that they were contributing towards stability within the client’s lifestyle. This can be seen as a direct reflection of ways in which the AO team appeared obliged by the institutional needs set out for their role. The team came to place importance upon delivering support as a significant feature of their work, which has extended into supporting this particular client’s physical health and well-being even though that was at the expense of the client’s independence and autonomy and wider construction of them as a capable citizen.

This form of engagement was also found to be a method through which they could discuss any issues, of a personal nature, with the service users. Therefore, what Social Outings represented was a way in which the team were attempting to develop a relationship with a client. Developing a relationship is seen as an important aspect of the AO team’s role for a variety of reasons but importantly because it provides a way in which the team can gather as much detail about the person as possible. Developing rapport facilitates this. It is seen as a way of gaining a detailed understanding of individual service users’ behavioural nuances and their individual needs, consequently gaining trust, increasing engagement between the service user and services, and ultimately increasing service users’ co-operation with the requirements laid down by the team for their behaviours and actions. In this way, another key purpose of the AO role is fulfilled.

By taking into consideration the implications and consequences of the interplay between these symbolic objects and their respective meanings, it was apparent that interactions between the AO team and service users were strongly influenced by institutional imperatives.

Ultimately, it was the interplay between these constructions and the consequential actions of the team that demonstrated how individual clients arrived at the AO team with a baggage of behavioural markers that had already shaped their social (or clinical) identity in the eyes of the team. This was apparent from the case note studies which illustrated how each individual client builds up a portfolio of constructed strengths and weaknesses, trigger points, risks and other behavioural qualities that profoundly influence the relationships they have with mental health services. These constructed behavioural markers were identified as service users having a dependency on services, demonstrating undesirable behaviours, posing potential risks to self and others. Likewise, the influence of diagnostic labels, as well as key influential institutional components such as the referral process, what makes an eligible candidate, similarly the influence and emphasis placed upon the identification of relapse signs and an individual’s perceived level of insight and capacity are the key symbolic meanings that influence and direct these therapeutic interactions. Understood in terms of the wider organisational context, the strong influence of a medical model approach is clearly imprinted on these constructed terms, which demonstrates how dominant an influence it is, and how it impacts on the way in which clients are perceived and acted towards, even in the context of a community mental health team explicitly contracted to carry out psychosocial interventions.

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