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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.
- Sales Rank: #3395224 in Books
- Published on: 2002-03-15
- Original language: English
- Number of items: 1
- Dimensions: 8.96" h x .60" w x 6.22" l, .83 pounds
- Binding: Paperback
- 286 pages
Review
This book provides a fascinating albeit bleak insight into the daily routine of practitioners.
(Camilla Parker European Journal of Public Health)
Review
This work provides essential insights into the helping process, identifying those elements that are fundamental but often are not incorporated into our intervention models.
(Jeanne Marsh, School of Social Service Administration, University of Chicago)
Paying close attention to language and meaning, Jerry Floersch's study documents how practitioners find ways to work around the limitations and inconsistencies of practice models to meet unique service needs while seeking to stay within the spirit of the model. The book is vivid and astute, wonderful as history, as critique, and as a framework for future research.
(James W. Drisko, Smith College School of Social Work)
Anthropologists will find this ethnographic and historical study of social workers and their practices in mental health an invaluable contribution to our understanding of how Foucauldian disciplinary knowledge and power operates in the everyday lives of human service workers.
(Philippe Bourgois, University of California, San Francisco)
Rich in theory and compelling and illuminating description, Meds, Money, and Manners challenges conventional understanding about the working and effect of disciplinary power as it guides readers through the confusing and contradictory landscape of deinstitutionalization. Social workers and policymakers, as well as historians and sociologists of mental illness and its treatment will find much of interest in this engaging book
(Elizabeth Lunbeck, Princeton University)
This is the most intensive and thorough study of case management practice that I have ever read.
(Joseph Walsh, School of Social Work, Virginia Commonwealth University)
About the Author
Jerry E. Floersch is an associate professor at the Rutgers University School of Social Work, New Brunswick, �New Jersey.
Most helpful customer reviews
3 of 3 people found the following review helpful.
a groundbreaking study
By Joel Kanter
"Meds, Money, and Manners" is another far-ranging "case study" of a treatment milieu for persons with severe mental illnesses. Floersch's volume spotlights an exurban/suburban community support program near a midsized Kansas city, focusing on the case management services by this publicly funded agency.
Like Stanton and Schwartz's study of Chestnut Lodge and Estroff's study of PACT, Floersch examines a program which would easily be rated by many contemporaries as an exemplar of the available treatment today. In the case management program of "High County", caseloads are small, case manager retention is above average, a coherent, empirically tested intervention model is used, and nearly 400 clients are provided with wraparound services that include medications, money management and residential assistance. In short, this program would be the envy of most mental health administrators across the United States.
But Floersch, using an ethnographic approach, takes the reader beyond the "glossy brochure" of low caseload size, home-based care, and "consumer empowerment" and illustrates the reality of case management practice in High County. Relying primarily on direct observation of case manager activities and on case manager reports of their work, both written and oral, he eloquently describes the dilemmas that case managers face as they attempt to operationalize conflicting mandates: first, to enable "consumers" to use their "strengths" to fulfill their wants or desires; second, to promote a policy of deinstitutionalization that dramatically reduces hosptial beds and the use of other residential facilities; and third, to address client needs to maintain clinical stablity and community survival.
The efforts of the High County case managers to address such issues was complicated by their training in the Strengths Model of case management. To help orient the reader to the Strengths Model, Floersch accompanies the case managers through a two-day Strengths Model training and he reports how this model was orally presented to neophyte case managers. Case managers were presented with a simple intervention framework that focused explicitly on consumer "wants" (as opposed to "needs"). Case managers simply ask clients what they "want" and then help them fulfill these desires through a sequence of achievable goals. Throughout, the stress is on avoiding diagnostic labels and characterizations of psychopathology.
After describing this training, Floersch presents material directly gleaned from staff conversations, team meetings and client records to illustrate the main thesis of his book: the discrepancy between "situated" and "disciplinary" knowledge, the disparate ways in which case managers intellectually tackle the challenges of their professional work. By "situated" knowledge, Floersch refers to the intuitive, "common sense" conceptualizations used by all case managers and by "disciplinary" knowledge, he refers to knowledge that comes from an explicit conceptual framework.
Chapters on "money" and "meds" delve farther into these discrepancies. High County case managers assumed considerable responsibility for client care in both domains. For many clients, case managers managed disability payments, doling out spending money, paying bills and taking clients on shopping excursions. And for other clients, they used a discretionary fund for emergency situations.
Consequently, case managers were continually facing financial questions that reflected underlying concerns and conflicts. For example, should a client be allowed to spend money freely on his or her "wants" (a la the Strengths Model) when such spending used funds needed for rent or groceries?
Floersch's chapter on "meds," the array of 47 psychotropic medications used in the High County community support system, is perhaps the best description available of how medications are actually used in a contemporary community program. Since the High County case managers were directly involved with their clients' use of psychiatric medications, the immediacy of the case managers' involvement with their clients' psychiatric disorders necessitated the usage of an "illness" model in their work that was directly at odds with the Strengths Model perspective. As with problems involving money, the case managers were forced to use their "situated" or commonsense knowledge to address such everyday challenges.
In contrasting the "situated" and "disciplinary" practice of the Kansas case managers, Floersch is not critical of the case managers' "situated," commonsense interventions. He finds much to admire in their dogged persistence, commitment to their work, and intuitive judgment, describing how they intuitively adapted their activities to address the personal and social contingencies they came across on a daily basis.
In conclusion, Meds, Money and Manners is a unique contribution to the mental health literature which deserves to be read by all involved in delivering services to persons with mental illness, including policymakers, human service administrators, program directors and supervisors, and front-line staff. Many readers, however, will find Floersch's intermittent academic discourses on Foucault and related intellectuals of little interest. Many readers will prefer skim these sections and focus on the Floersch's compelling description of contemporary case management. "Meds, Money and Manners" is an opportunity for all in community mental health to reflect on the discrepancies between ideologies and actual practice; perhaps it might lead to a more honest and open dialogue among all in the mental health system.
0 of 1 people found the following review helpful.
5 stars for subject matter minus 2 stars for Foucault...
By Shelley Ashfield
I bought this book to see best practice case management of mental health patients. If you can wade through the author's digressions on Foucault and word-meanings and deconstruction, we can hear some things that sorely need to be addressed by the caring community, namely that:
Medication management for patients is the central criteria for whether they are functional or back in the hospital. Yet the social workers studied display an alarming ignorance about psychopharmacology. For those that are purchasing this book for a class, PLEASE TAKE JERRY FLOERSCH'S OBSERVATION TO HEART. If classes do not cover this, Ronald J. Diamond's Instant Psychopharmacology will fill the bill. If you are a working with the mentally ill, you MUST know a few things about meds!!! Like drug interactions, side effects, knowing when side effects kick in vs. when therapeudic action kicks in, and whether there is a delay in effect when the meds are stopped.
What do you do when:
1) Your client quietly stops taking their meds and looks fine until surprise, surprise, they relapse and decompensate?
2) Your client complains to family or doctors about side effects and finds themselves on meds that are more expensive, less effective, have more side effects than before, and are now at greater risk of stopping their meds?
3) Your client complains about the cost of their meds and uses that as an excuse to stop them?
4) Your client assures you they're taking their meds, but their home is trashed and they've stopped any pretense at hygiene?
Forewarned is forearmed. Those meds are your client's lifeline in this business, and for their sake and your conscience, clients deserve to have social workers that know their meds.
I hope Mr. Floersch puts out a second edition of this book, after it is edited by someone other than an academic, who can improve upon the book's readability and simplicity of prose. Then it will truly deserve 5 stars.
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