Being a Case Manager - Doing Case Management; Translating Political Policy to Pratice

Abstract: Case managers and Case management were implemented in the Swedish mental health care system as a result of political policies which aimed towards the empowerment of mentally disabled clients. This thesis engages the implementation of policy into local practice in terms of a translation process performed by case managers as they go about understanding and handling their everyday labour conditions. The empirical material consists of 15 interviews and many more informal conversations with case managers, as well as 3 participant observations of interactions between case managers, their clients and other human service workers in the course of producing client empowerment. The empirical material is analysed from a grounded theory approach in dialogue with a critically relativist perspective and social psychological theories on constructions of social reality and selves. Resultant categories were subjected to situational analysis, individually as well as collaboratively, focusing relationships between social acts and contextual aspects of power. Empirically the study contributes with an understanding of how case manager’s experiences and handling of their labour conditions affect mentally disabled clients possibilities of empowerment within the Swedish mental health care system. Results show that the case managers’ labour conditions are primarily structured by two labour conditions: The need to balance between the purpose of empowering clients and the organization’s financial interests, and the need to manage a lack of a mandate which is accepted in practice when coordinating the efforts of other human service workers. It is further shown that case managers hope for a change and act to socially negotiate mandate to be able to fulfil their duties of coordinating other human service workers as well as actively seek long-term empowerment through professionalization. It is further shown that the organizations financial interests sometimes disempower both case managers and clients alike by restricting the case managers’ space of action. Together the results suggest client empowerment is ultimately a product of what the case managers perceive that the organization is willing to pay for, rather than a principal right for mentally disabled clients to hold the power to choose for themselves. Theoretically the study pushes at a central concept in the sociology of work; the ‘service triangle’, by demonstrating that middle managers aren’t necessarily a proxy for the abstract organization. A methodological contribution is that the study demonstrates how an application of a critically relativist social psychological perspective can be used to study how constructions of social reality impact organizational results in tangible and real ways.