Academic journal article Health Sociology Review

Embodying Policy-Making in Mental Health: The Implementation of Partners in Recovery

Academic journal article Health Sociology Review

Embodying Policy-Making in Mental Health: The Implementation of Partners in Recovery

Article excerpt


A reflection on embodied knowledge is important for understanding consumer accounts of health and illness and it is this aspect of experiential knowledge which is considered primarily in health sociology. However, a consideration of the embodied knowledge of practitioners and policy-makers is critical to understanding the practices of the health system that create the administrative regimes consumers experience in their healthcare encounters. For that reason, we focus in this paper on the micro practices of policy and identify the way embodied knowledge is enacted by those that implement policy through their day to day work. We use as a case study Partners in Recovery (PIR), an Australian Federal Government policy implemented in local healthcare regions in order to coordinate services for people with severe and complex mental ill-health. We begin by introducing the PIR program and then introduce the theoretical approaches through which we interpret the data.

Background: the PIR program

Throughout the 1990s and 2000s, Australian mental health care was repeatedly characterised as in 'disarray', with multiple reports documenting problems (Rosenberg, Hickie, & Mendoza, 2009; Whiteford, 1992), particularly in coordination which had led to disorganisation and fragmentation of services (Banfield et al., 2012). To understand the system, one must be literate in its funding arrangements, different accountabilities, alliances and competitive providers, and for an individual experiencing mental ill-health, particularly those whose lives are made more difficult by comorbid illnesses and social needs, the system is almost impossible to navigate. However, successive policies have had little success in creating a cohesive system which allows those with mental ill-health to easily access the services they need (Whiteford et al., 2014).

PIR was a 2012 initiative of the Gillard Labor government aimed at a national, but decentralised solution to these coordination problems, enacted in local regions (for a more in-depth understanding of the PIR program refer to: Brophy, Hodges, Halloran, Grigg, & Swift, 2014; Smith-Merry, Gillespie, Hancock, & Yen, 2015). Government announcements launching or promoting PIR articulated the health and social support systems for mental ill-health as riddled by 'gaps', 'cracks', wrong turns and disconnection through which individuals must 'battle' (Butler, 2012):

One of the most consistent themes fed back to the Australian Government is that care for the most vulnerable people with severe and persistent mental illness is not adequately integrated or coordinated, and people with complex needs often fall through the resulting gaps. (Department of Health and Ageing [DoHA], 2012b, p. 10)

The potential PIR client1 was also seen as the source of the problem with their 'complex needs', propensity to 'fall through the gaps', and 'disconnection' (DoHA, 2012a; PIR operational guidelines 2013). They were also seen as prone to 'extensive reliance' on multiple services (Department of Health [DoH], 2014b). The policy problem was therefore a problem with two parts. One was the fractured mental health system. The other was those with 'severe and persistent mental illness' (DoH, 2014b). Both of these problems actually related to people, their embodied actions and their interactions with systems of organisation for the implementation of mental health policies. A healthcare system is, at a micro level, made up of the interactions between people who have different embodied knowledge of the system and therefore act on a policy in different ways (Flood & Fennell, 1995).

The solution proposed by PIR was a system based on coordination and collaborative working. The Commonwealth government contracted with lead agencies in 48 Medicare Local (primary care) regions across Australia in 2013 to run PIR. These agencies then formed consortia of non-government organisations already working in health and social care. …

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