Care planning: a neoliberal three card trick

Abstract

Introduction The three card game, sometimes called find the queen, is a classic confidence trick, typically taking place on an impromptu table top, set up on pavement or street corner. The tricksters usually operate in teams, pulling in punters and 'losing' games with their fellows to persuade prospective speculators the game is winnable. For our titular purposes the three card trick serves as a metaphor for broader deceits. We are concerned with how well-meaning mental health nurses can enter into a set of apparently rational practices, insisted upon by policy and protocol, seemingly motivated by ideals of care and protection from harm, yet functioning to destroy the very essence of what it might mean to be a caring, progressive practitioner by contributing to a mutuality of alienation that, at the relational level, is the opposite of what services intend to achieve. This may prove to be the case because an external confidence trickster (neoliberalism) is actually in charge, and the real function of the game serves other ends. The whole point of the game is that genuine players can never win, and for the trickster to triumph it is necessary that these punters are willing, gullible and in most circumstances accept losses without too much fuss. When the losers do not go quietly this is referred to in the argot of the con as 'squawking', and personnel are deployed on the periphery to ensure any squawk is minimised. Various strategies can be used to 'cool out the mark', and are analogous to the means by which people are assisted to adjust to life's disappointments in other contexts, including encounters with priests or sundry psy-professionals (Goffman 1952; McKeown et al. 2013). This commentary paper seeks to provoke nursing out of its state of gullibility and self-deception even if this involves painful reflection on the losses inherent in our collective game of mental health care. If we are to defend the importance of mental health nursing we must think more critically about our complicity within oppressive systems of control and do something about it. There is a lengthy critical tradition to draw on. We urge mental health nurses to squawk, asserting a more recalcitrant and rebellious standpoint, preferably in alliance with service users, refusers and survivors. Acknowledging the constraints upon nursing's agency, deficits of power, and structural disadvantage need not default to impotence and inaction: collective resistance is always possible, however difficult the circumstances. The set up: our argument in a nutshell First, we provide a critique of Neoliberalism and consequences for mental health and mental health care. Second we indicate how this might be remedied via democratisation. Care planning can be located within a wider panoply of administrative tasks that implicitly service social governance functions acceded to psychiatry from neo-liberalism under risk society (Beck 1992). We are, thus, concerned with questions of power and control in both society and the management of care and how these are worked ...

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Care Coordination as Imagined, Care Coordination as Done: Findings from a Cross-national Mental Health Systems Study

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Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…McKeown, Wright and Mercer (2017) stress that 'them and us' cultures contribute to poor patient experiences in alienating environments, which further feeds a notion that overly coercive approaches from staff still remain. In order to build effective relationships, it is often necessary for professionals to relinquish some of their power (Warne & McAndrew, 2007).…”

“…This distance that nurses are seeking, is almost the opposite of what is required in service user involvement in nursing processes, therefore a close proximity to service users. McKeown et al, (2017) stress that nurses are deceiving themselves if they try to justify excessive time needed for office paperwork at the expense of direct care. These apparently rational practices in which nurses engage, including copious documentation and risk assessments, recommended in policy documents, seemingly motivated by ideals about care, actually function to destroy the very essence of what it might mean to be a caring professional worker.…”

“…These apparently rational practices in which nurses engage, including copious documentation and risk assessments, recommended in policy documents, seemingly motivated by ideals about care, actually function to destroy the very essence of what it might mean to be a caring professional worker. One argument suggested by McKeown et al (2017) suggest this is the opposite of what services intended to achieve, and compare this to a confidence trick. Mental health nurses may or may not be pulling the wool over their own eyes, but are complicit in persuading people into a game, which distracts people from the very real issues of structural problems in the health service and limited resources.…”