Meds, Money, and Manners

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

Copyright Date: 2002
Pages: 286
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  • Book Info
    Meds, Money, and Manners
    Book Description:

    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.

    eISBN: 978-0-231-50481-2
    Subjects: Sociology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Tables
    (pp. ix-x)
  4. Acknowledgments
    (pp. xi-xiv)
  5. CHAPTER 1 Introduction
    (pp. 1-16)

    I worked with and studied case managers while they mobilized resources in a mental health organization to enable former hospital patients to continue living in communities. In this book I am primarily concerned with the ways managers use case management theory to produce apartment-dwelling consumers of mental health services. The policy is deinstitutionalization and the practice is case management. Sometimes called “continuum-of-care” or “community reintegration,” case management depends heavily on the policy emphasis given to short stays in hospitals. And successful programs are measured by their capacity to divert patients from hospitals to community resources.

    Researchers, policy advocates, and practitioners...

  6. CHAPTER 2 The Formation of Community Support Services
    (pp. 17-41)

    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...

  7. CHAPTER 3 The Rise of the Case Manager
    (pp. 42-60)

    The National Institute of Mental Health, the Kansas Department of Mental Health, and the local mental health center used policy initiatives, administrative mandates, new funding sources, and everyday experience to construct a rudimentary community-based social field, the new home for the former hospital “patient.” The CSS social field had secured juridical claims to the deinstitutionalized population; thus, as specified by Andrew Abbott, the objective conditions for professional work were in place. In this chapter, I show how Abbott’s subjective conditions of work—diagnosis, assessment, and treatment activities—were not fully developed, however, suggesting that workers relied on raw experience that...

  8. CHAPTER 4 Strengths Case Management
    (pp. 61-82)

    Developed at the University of Kansas School of Social Welfare (KU), strengths case management was commonly used at mental health centers in Kansas. At the time of my study, CSS program directors were obliged, in exchange for receiving state management monies, to send their case managers to strengths workshops. Sponsored by the School of Social Welfare, Office of Mental Health Research and Training, which had a contract with the state of Kansas to provide technical assistance and training, two-day training workshops were offered to case managers. The office also collaborated with the Kansas Division of Mental Health to monitor and...

  9. CHAPTER 5 Landscape for a Case Manager: The Carless Mentally Ill
    (pp. 83-107)

    The arrival of the semimonthly mileage check routinely generated excitement among case managers. Some would plan a celebratory lunch. Others wanted to pay an onerous phone bill or satisfy their desire for an exotic vacation. “Unlike some around here, my mileage check is banked, and then I use it to replace my car every three or four years. I don’t like the wear and tear on my car; it is the one thing about this job that I get tired of.” The amount of the check had two meanings. One was the simple gratification of having more “money in my...

  10. CHAPTER 6 Oral and Written Narratives of Case Managers
    (pp. 108-124)

    Historians and sociologists have recently discovered social work case records and are using them to write the history and sociology of social work practice (Kunzel 1993; Gordon 1994; Odem 1995; Margolin 1997; Tice 1998). These works generally disregard the limits of textual analysis, especially when they rely entirely on the case record. And for many, the written texts produced by social workers represent the totality of practice, policy, organization, and theory. Many lead us to believe that the written text is a facsimile of actual practice, as they debate the problematic nature of objectifying clients through the writing of “cases”...

  11. CHAPTER 7 Money
    (pp. 125-149)

    It can be said that money is the measure of successful deinstitutionalization. Nineteenth- and twentieth-century social welfare projects moved adults and children out of “totalizing” institutional spaces—the workhouse, the almshouse, the orphanage, the nursing home, the mental hospital—with income maintenance schemes (Lerman 1985, 1982). Policy debates about outdoor and indoor relief were fundamentally about reducing poverty by distributing money directly to the poor (Patterson 1986). The almshouse and poor farm provided food and shelter on-site and their demise was predicated on cash transfer programs assisting the poor in private homes. Aid to Dependent Children (ADC), for example, established...

  12. CHAPTER 8 Meds
    (pp. 150-179)

    Since the mid-1950s treatments for schizophrenia and manic-depressive illnesses have been revolutionized by a kind of chemical warfare. In 1952 Delay and Deniker reported in the Congrès des Médecins Alienistes et Neurologistes de France the results of their research on Thorazine, sometimes called chlorpromazine. Soon, others were reporting on the beneficial effects chemicals could have in treating intractable mental illnesses (Swazey 1974). By 1960 Thorazine, a neuroleptic drug, was being widely used in our state mental hospitals (Gelman 1999). This particular chemical and others to be discussed below, researchers argued, acted on the “positive” symptoms of schizophrenia—especially delusions, hallucinations,...

  13. CHAPTER 9 The Helper Habitus: Situated Knowledge and Case Management
    (pp. 180-201)

    For Mary Richmond subjective classifications were among the practices to be purged from the emerging profession of social work. Yet they remained and are today embedded in the situated knowledge and practice of case managers. Richmond, central to the project of developing social work’s disciplinary knowledge in the early part of the last century, was Roy Lubove’s (1965) ideal “Professional Altruist.” She was not alone, however. Others among the early architects of social work sought to bury the intuitive knowledge and practice of the “friendly visitor” beneath the language of positivist science.

    By way of the casework method, most sought...

  14. CHAPTER 10 Conclusion
    (pp. 202-214)

    I have demonstrated that the study of case managers requires multiple research methods and a view of practice power that includes the disciplinary and the situated. In this final chapter I summarize my findings for the purpose of drawing attention to the implications for research and practice. I argue that strengths case management suppresses theories of the self, and this compels case managers to aim disciplinary power at the surface level of the mental health reality. In addition, I discuss a perplexing irony: deinstitutionalization and normalization of mental illness did not preclude the need for monitoring by practitioners. Instead, the...

  15. APPENDIX A. Methods, Data, and Analysis: A Critical-Realist Perspective
    (pp. 215-220)
  16. APPENDIX B. Continuum of Services
    (pp. 221-222)
  17. APPENDIX C. Interview Schedule
    (pp. 223-226)
  18. Notes
    (pp. 227-234)
  19. References
    (pp. 235-248)
  20. Index
    (pp. 249-266)