The psychodynamics of mental health care

Abstract

This paper draws on both psychoanalytical and systems theory to consider how the creation and maintenance of community mental health teams can impact upon the relationships between team members, as well as upon the relationships of those members with managers and users. It argues that mental health services present a range of polarities or splits, for example, between strategy and operational activity; between theoretical model and personal responsibility; and between professional and agency allegiance. In so doing, the paper draws heavily on Kleinian ideas, transposing them from the person to the team or organisation. This paper thus seeks to address a number of inter-related themes: the extent to which managing mental health services requires an understanding of the psychological processes of care; the ways in which mental health care is by nature psychodynamic, and inter-relates users, clinicians and managers in complex and often uncomfortable ways; the insights to be gained from analysing the fragmentary way in which mental health care is provided, and by implication the 'chaotic' response to the needs of service users; and the implications of mental health teams being an unstable but apparently necessary form of organisation within mental health services. The paper concludes with a series of recommendations concerning the effective management of these teams.