Enhanced quality or assembly lines? Psychiatric treatment packages in Denmark: knowledge definitions and governing tools. Issue 4 (November 2018)

• Record Type: Journal Article
• Authors: Trojaborg, Rebecca
• Is Part Of: Social theory & health. Volume 16:Issue 4(2018)
• Page Start: 342
• Page End: 360
• Publication Date: 2018-11
• Subjects: Psychiatry -- Mental health -- Dispositive -- Treatment pathways -- Treatment packages -- Foucault; Health -- Social aspects -- Periodicals; 306.461
• DOI: 10.1057/s41285-018-0061-x
• Languages: English
• ISSNs: 1477-8211

Abstract

Abstract Since 2013, all treatment at out-patient psychiatric centres in Denmark has been organised in standardised trajectories called "treatment packages". While the political aim of these is to enhance quality, the staff of the psychiatric centres has compared the new work conditions to those of factories. In order to elucidate these contrasting descriptions, the article analyses central knowledge definitions and governing tools of the treatment packages based on Michel Foucault's concepts of the dispositive, knowledge, power and freedom. The article identifies two competing assemblages: "uniformity" and "individuality", and demonstrates how the former restricts the latter from being practiced, placing managers and staff in a cross-pressure situation, where they are asked to make incompatible ends meet. The managers and staff exercise freedom by not only trying to negotiate but also bypassing governing tools through creative solutions and trickery. The relevance of the dilemmas identified in the article pertains to epistemic and practical dilemmas in health services in general, where clinicians are protesting against the political and administrative interference with the definition of treatment quality and aims, as well as the incompatible obligations often instigated by NPM and quality control policies.