Meds, Money, and Manners: The Case Management of Severe Mental Illness

Meds, Money, and Manners: The Case Management of Severe Mental Illness

Meds, Money, and Manners: The Case Management of Severe Mental Illness

Meds, Money, and Manners: The Case Management of Severe Mental Illness

Synopsis

As case management has replaced institutional care for mental health patients in recent decades, case management theory has grown in complexity and variety of models. But how are these models translated into real experience? How do caseworkers use both textbook and practical knowledge to assist clients with managing their medication and their money? Using ethnographic and historical-sociological methods, Meds, Money, and Manners: The Case Management of Severe Mental Illness uncovers unexpected differences between written and oral accounts of case management in practice. In the process, it suggests the possibility of small acts of resistance and challenges the myth of social workers as agents of state power and social control.

Excerpt

Social work has long had an interest in challenging and dismantling congregated care or residential institutions. Among the names given to such projects are “placing out,” “aftercare,” and “community support services.” Social work carved out of the liberal welfare projects of the late nineteenth century a workplace between the surrogate home—the residential institution—and the “real” home, the one of “person-in-community.” Deinstitutionalization is not new to the profession of social work; indeed, the project to empty institutions has defined the profession for a long time.

The eighteenth-century almshouse was a universal institution; it clustered the aged, the physically and mentally disabled, and the poor as well as other outsiders at one site. The project of reclassifying and then separating out the disparate groups of the elderly, infirm, and mentally ill began in the early nineteenth century and was largely completed by the 1920s. The breakdown of the almshouse, the first project of deinstitutionalization, produced categorical institutions: the orphanage, the home for the aged, the charity organization society, the house of refuge, the home for unwed mothers, the boys' and girls' home, and the mental hospital (Trattner 1999; Katz 1986; Patterson 1994;Lubove 1965). With each emerging institution there developed unique locations, spatial arrangements, and practitioners, each with professional languages to classify and control its particular inmates. Recent research shows that of the professions coming to the fore during the Progressive era, social work crossed most institutional boundaries. For example, in Andrew Polsky's work, The Rise of the Therapeutic State (1991), social workers helped define . . .

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