Constructing the Elements of the "Recovery in" Model through Positive Assessments during Mental Health Home Visits.

The study provides a categorization of the different elements of the “recovery in” model (RIM). The objective is to analyze elements of RIM in positive assessments during home visit interactions. RIM approaches mental illness as a long-term condition that people live with in their daily lives in their communities. The model emphasizes the rights of all citizens to be full members of their communities regardless of their mental health problems or other difficulties. Positive assessments are professionals’ encouraging evaluations of the activities, situations, or inner conditions expressed by the clients. They are essential in creating supportive professional-client communication. The data analyzed in this study consists of 17 audio-recorded home visits of 10 different clients. Home visits were provided by a mental health floating support service in 2012. The data was analyzed using coding and ethnomethodological interaction research (EIR). As a result RIM is divided into two upper-categories: “Encouraging Doing the Right Thing” and “Encouraging the Right Kind of Personal Growth”. These categories include a wide spectrum of elements that are relevant for the client’s agency in the community. The elements embed the client’s performance in everyday routines and the client’s progress in becoming a skillful, knowledgeable, and involved agent in the community. The categorization of the elements of RIM could be used in educating practitioners to identify and operationalize RIM in mental health home visits.

Tackling community integration in mental health home visit integration in Finland.

Integration - and its synonym inclusion - is emphasised in the western welfare states and in the European Union in particular. Integration is also a central topic in the social sciences and in current mental health and homelessness research and practice. As mental healthcare has shifted from psychiatric hospitals to the community, it has inevitably become involved with housing and integration issues. This article explores how community integration is understood and tackled in mental health floating support services (FSSs) and, more precisely, in service user-practitioner home visit interaction. The aim, through shedding light on how the idea of integration is present and discussed in front-line mental health practices, is to offer a 'template' on how we might, in a systematic and reflective way, develop community integration research and practice. The analysis is based on ethnomethodological and micro-sociological interaction research. The research settings are two FSSs located in a large Finnish city. The data contain 24 audio-recorded and transcribed home visits conducted in 2011 and 2012 with 16 different service users. The study shows how the participants in service user-practitioner interaction give meaning to community integration and make decisions about how it should (or should not) be enhanced in each individual case. This activity is called community integration work in action. Community integration work in action is based on various dimensions of integration: getting out of the house, participating in group activities and getting along with those involved in one's life and working life. Additionally, the analysis demonstrates how community integration work is accomplished by discursive devices (resistance, positioning, excuses and justifications, delicacy and advice-giving). The article concludes that community integration is about interaction: it is not only service users' individual challenge but also a social challenge, our challenge.

Boundary work in inter-agency and interprofessional client transitions.

This article analyses the accomplishment of boundary work performed by professionals engaged in inter-agency collaboration. As a means of building authority within a particular field, boundary work is found to be a common feature of most professional practices. By analysing the talk of Finnish professionals who work in the field of supported housing in mental health, the article investigates the ways professionals--as collective representatives of their service--talk about doing boundary work when transferring their clients to another agency. The study drew on the principles of exploratory case study design and ethnomethodology. A key finding from the analysis of professionals' focus groups and team meetings indicated that boundary work is employed when disputes arise between supported housing and collaborating agencies. The article goes on to suggest that professionals accomplish boundary work by rhetorically presenting themselves as holders of "day-to-day evidence" of clients' mundane living skills and serious ill-health. The paper concludes by arguing that in inter-agency collaboration, boundary work building on day-to-day evidence is used to influence the decision on the most appropriate living arrangement for the client. Boundary work is also used for boosting the authority of professionals as representatives of a relatively new and fixed-term agency in the service system.

Causal accounts as a consequential device in categorizing mental health and substance abuse problems.

Professionals in human service work are at the centre of complicated client cases. The ways client cases are constructed and the problems explained form the basis for professionals' assessments, decisions, actions and interventions. In this article the ways professionals make sense of dual-diagnosis client cases are examined. Applying the concept of causal accounting, it is argued that 'theories of cause' are embedded in professional discourse and profoundly shape professionals' understandings of social and health problems, as well as of their own roles and responsibilities and of what interventions and outcomes are possible. The data consist of 48 tape-recorded weekly team meetings among professionals in a supported housing unit targeted for clients with both mental health and substance abuse problems. It was found that professionals reason about the relationship between these two problems in four different ways: (1) substance abuse causes or makes mental health problems worse; (2) substance abuse eases mental health problems; (3) mental health problems cause or make substance abuse worse; or (4) good mental health reduces substance abuse. Causal account research makes visible the ways professionals do institutional work by categorizing clients, accounting for responsibilities as well as assessing their work and clients' achievements according to moral expectations of a 'good'professional and a worthy client.