Developing Normative Integration among Professionals in an Intersectoral Collaboration: A Multi-Method Investigation of an Integrated Intervention for People on Sick Leave Due to Common Mental Disorders

Poulsen, Rie Mandrup; Pii, Kathrine Hoffmann; Bültmann, Ute; Meijer, Mathias; Eplov, Lene Falgaard; Albertsen, Karen; Christensen, Ulla

doi:10.5334/ijic.4694

Cited by 20 publications

(29 citation statements)

References 43 publications

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“…Previous studies, focusing on patient participation in mental healthcare, corroborate our findings of paternalistic steering in which the professionals chose which efforts and goals were the right ones for the users’ intersectoral journeys. 21,52–55 Also, in accordance with others, 22–25 our findings reflected that the healthcare professionals worked in a silo structure where the long-term perspective of the user’s intersectoral journey disappeared. Much of the existing research mainly focuses on the transition itself, e.g.…”

Section: Discussionsupporting

confidence: 86%

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Coherence in intersectoral collaboration between psychiatric centres and community mental healthcare: A critical discourse analysis

Jørgensen

Dahl

Frederiksen

2020

Nordic Journal of Nursing Research

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There is scarce research studying healthcare professionals’ and users’ perceptions in relation to creating coherence in intersectoral collaboration between psychiatric centres and community mental healthcare. Drawing on the discourse analysis framework of Fairclough, this study aimed to explore how healthcare professionals and users could perceive coherence in intersectoral collaboration between psychiatric centres and community mental healthcare. But also to explore their perception of how coherence could be maintained through an intersectoral journey, and what discourses manifested themselves within the field of mental healthcare. Data were collected through 11 focus group interviews, five of which with healthcare professionals ( n = 20) and six with users ( n = 18). Fairclough’s three-dimensional model for the studying of discourse was used to analyse the transcribed texts. This study is reported in accordance with the COREQ checklist. Coherence in intersectoral collaboration was interpreted to exist in tension between being predominantly steered by the healthcare professionals while the users had a desire to be more involved in decisions regarding their own intersectoral journey. The users were subjected to a paternalistic steering, expressed by the power of the healthcare professionals to select the right efforts as well as the purpose of the users’ journeys. The findings showed that coherence in intersectoral collaboration in general was articulated from an overall discourse of neoliberal governance, with its embedded discourses of rationality and structure, and discourses of linearity, objectivity, paternalism, biomedicine and evidence have a controlling influence on how users should guide themselves based on the discourse of self-care.

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Section: Discussionsupporting

confidence: 86%

“…18–21 Healthcare professionals and users are caught in institutional silo-style thinking which becomes a barrier to creating coherence in a collaboration that stretches across different sectors. 22–25…”

Section: Introductionmentioning

confidence: 99%

Coherence in intersectoral collaboration between psychiatric centres and community mental healthcare: A critical discourse analysis

Jørgensen

Dahl

Frederiksen

2020

Nordic Journal of Nursing Research

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“…Co-location and daily collaboration supported the integration and reduced internal professional conflicts. Professionals described employment specialists’ part-time employment as problematic because it prolonged the establishment of integrated collaboration and tied employment specialists to the aims and values of the conventional municipality vocational rehabilitation [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…The IBBIS intervention was launched and tested as part of a large reform of the Danish sickness benefit legislation which aimed to fasten provision of support and thereby return to work rates [ 25 ]. The intervention was delivered in four Danish capital municipalities by two multidisciplinary teams consisting of employment specialists, care managers, a psychiatrist and a psychologist [ 20 21 ] (study results regarding the intersectoral collaboration is reported in [ 26 ]).…”

Section: Theory and Methodsmentioning

confidence: 99%

Shared Decision Making in an Integrated Mental Health and Vocational Rehabilitation Intervention: Stakeholder Practices and Experiences

Pii¹,

Hybholt²,

Poulsen³

et al. 2020

International Journal of Integrated Care

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Introduction Common mental disorders such as depression, anxiety and stress disorders are frequent causes of sick leave in high-income countries, including Denmark [1-4]. In Denmark, common mental disorders are the main reason for early retirement [2, 5], and anxiety and depression alone account for annual production losses of 1.6 billion Euros (2010-2012 price levels) caused by absence from the labour market due to sick days, early retirement benefits and early death [2]. People with common mental disorders who want to keep, return to or find a job often have a combination of social problems and health issues that call for integration of public services but are often met with fragmented and uncoordinated services [6]. Research has shown that adequate mental health care cannot stand alone when supporting people in returning to work [4]. Integration of health care and vocational services has shown to improve return to work for people with severe mental disorders [7, 8]. Only little evidence exists regarding the effectiveness or feasibility of intersectoral integration efforts for persons with common mental disorders [1]. However, integrating mental health care and vocational rehabilitation has proven to be difficult [9-11]. Research has identified cooperation between multidisciplinary stakeholders across sectors as one of the main barriers [6, 12, 13]. A meta-synthesis of client experiences with return-to-work interventions showed that the lack of coordination between public services left clients confused and uncertain about how and when to return to work. It was suggested that return-to-work processes

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“…Furthermore, medical notes for the sick leave case were produced by healthcare professionals from the integrated team. Despite the comprehensive structural integration efforts, the first process evaluation study showed that the collaboration initially led to conflicts, competition, and scepticism between professionals [ 37 ].…”

Section: Introductionmentioning

confidence: 99%

Developing Interpersonal Trust Between Service Users and Professionals in Integrated Services: Compensating for Latent Distrust, Vulnerabilities and Uncertainty Shaped by Organisational Context

et al. 2021

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Introduction: Studies show a need for trust between stakeholders in integrated services. However, few studies have investigated how trust develops between stakeholders on a micro-level. In a Danish intersectoral intervention for persons on sick leave due to common mental disorders, we explored why trust is needed and how trust is developed between micro-level stakeholders. Methodology: The qualitative study was based on 12 observations of inter-organisational meetings, 16 interviews with service users, 24 interviews with health care professionals and employment consultants, and 8 interviews with supervisors. The analysis was guided by the theoretical concepts (dis-) trust, vulnerability and uncertainty. Results: Latent distrust between involved organisations, and vulnerabilities and uncertainties related to employment consultants’ statutory power over service users caused a perceived need for interpersonal trust. Time to establish knowledge-based relationships, healthcare professionals’ caring approach, and creating a feeling of sharing interests were compensating trust-building strategies that were often regarded as positive. Discussion and conclusion: Trust in personal relationships between stakeholders appeared to compensate for contextually shaped distrust, vulnerability and uncertainty. Identifying latent distrust, vulnerabilities, uncertainties, and power structures might be key to improving trust-building strategies in a specific context. The time-consuming process of trust-building between micro-level stakeholders should be supported structurally.

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Developing Normative Integration among Professionals in an Intersectoral Collaboration: A Multi-Method Investigation of an Integrated Intervention for People on Sick Leave Due to Common Mental Disorders

Cited by 20 publications

References 43 publications

Coherence in intersectoral collaboration between psychiatric centres and community mental healthcare: A critical discourse analysis

Coherence in intersectoral collaboration between psychiatric centres and community mental healthcare: A critical discourse analysis

Shared Decision Making in an Integrated Mental Health and Vocational Rehabilitation Intervention: Stakeholder Practices and Experiences

Developing Interpersonal Trust Between Service Users and Professionals in Integrated Services: Compensating for Latent Distrust, Vulnerabilities and Uncertainty Shaped by Organisational Context

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