Paradigms in rehabilitation – treatment in social psychiatry

Background/Objectives: Being a resident at a Danish social psychiatric home implies in most cases also being affiliated to treatment psychiatry. In a macro perspective, both domains share the same purpose, i.e. to support the rehabilitation of the service users. However, social and treatment psychiatry in Denmark are divided into different public sectors, subjected to different laws, dominated by different professions and also, traditionally, subjected to different paradigms on how to work on rehabilitation. Social psychiatry has traditionally been subscribed to the recovery-orientation, while treatment psychiatry has traditionally approached mental illness as a chronic condition. The employees’ approach is of significant importance for the service users’ rehabilitation process. With the residents being affiliated to both, social and treatment psychiatry, a need for collaboration between the employees in the two sectors arises, in order to provide the service users with supplemental support. Sharing paradigms is an important factor in a good collaboration. This study aims at investigating which paradigms underlie the rehabilitative efforts in social and treatment psychiatry, how and to whom these efforts are sought legitimized, and what context this provides for the service users’ rehabilitation.

Methods: Data will be collected through participant observation and interviews/group interviews at a social psychiatric home, a district psychiatric center and a psychiatric hospital. It will be analysed using the methodological approach of grounded theory. New institutional theory and theory on professions will be used to investigate the legitimation, rationales, norms and logics in the different sectors and professions.

Results: The preliminary results indicate substantial differences between the paradigms of social and treatment psychiatric rehabilitation, with treatment psychiatry approaching rehabilitation by using different treatment methods. Employees in social psychiatry, on the other hand, seem to experience a dilemma between having to live up to new structural demands, minimising the possibilities of approaching the individual needs of each resident, and a belief that rehabilitation is facilitated through working individualised with each resident based on this persons needs and wishes. The employees in social psychiatry experience a shift in the demands on approach coming from the management and extern actors. This shift is appreciated differently by different professions within social psychiatry. Furthermore, results indicate that there is limited understanding of how employees in the other sector work and of their approach to facilitate rehabilitation. This lack of knowledge about the work of the other sector is stronger for employees in treatment psychiatry.

Discussion/Conclusions: Other research has found that there is an increasing demand for evidence based social work and for documentation of efforts within social work. The entrance of these new technologies may now result in a shift in the paradigm of social psychiatry towards approaching rehabilitation in a much more structural way, including structures reflecting treatment psychiatry. This may indicate a future narrowing of the paradigmatic gap between social and treatment psychiatry, thus facilitating better conditions for collaboration between the two sectors. However, transforming the social psychiatric effort will have great impact on the context in which residents are to undergo rehabilitation and the consequences should be carefully followed and considered.

Funding: This PhD project is funded by Copenhagen Municipality.

Keywords: Knowledge transfer, paradigm, rehabilitation.