The Shifting Labour Process in Professional Care: Recreating Dominance and the Managerialised Mental Health Social Worker

Though the rationalisation of health care has been well documented, less is known about its impacts on mental health social workers. Drawing on qualitative data collected from 120 interviews and the qualitative comments on a Canadian four-province survey, the article explores the shifting labour process through profession-linked and organisational care strategies. The article argues that power is shifted from mental health social workers to management through stratagems including managerialism, biomedical hegemony and team-based care. These processes are complex and dynamic, travelling along professional divisions and logics, appearing neutral and scientific rather than as conduits reinforcing neoliberalised approaches to health care provision. Social workers' resistance to these models of care is similarly complex and professionally based, though with strong elements of gendered altruism and social justice themes. Though this article draws on Canadian data, the analysis is likely highly applicable to other managerialised contexts including the UK. The article contributes to the intersection of Labour Process Theory and moral economy theory by highlighting the operation of a unique form of engagement referred to here as resistance-as-engagement. Overall, mental health social workers revealed strong oppositional narratives and identities pivoting on their marginalised position within team-based care, medical professional hierarchies and narrow, neoliberal approaches. Though cost cutting in health care has often been studied, less is known about the impact on mental health social workers. This article uses quotes from 120 interviews with mental health social workers in Canada who provide information on how cost cutting effects their work. It also includes written comments from a four-province survey in Canada. The article argues that power is shifted from mental health social workers to management through various processes including managerialism, biomedical hegemony and team-based care. These processes are complex and changeable. They reinforce professional power divisions in health care, though they appear neutral and scientific. Mental health social workers resist these models of mental health work in ways that are very complex and based on their professional values of care and social justice. Though this article draws on Canadian data, the analysis is likely highly applicable to other places, including the UK. It puts the spotlight on the operation of a unique form of social work resistance that the authors call 'resistance-as-engagement'. They show that mental health social workers have strong opposition to narrow, neoliberal approaches that they express this through the stories they tell themselves about the work they are doing, and by trying more empowering ways of working.