Synopsis of Crystal Grass' doctoral research in prison-hospitals
occupational therapists working within forensic environments, we
often become frustrated at being prevented from doing mental health
work due to the emphasis on security and correctional priorities.
We begin to wonder about the value placed on the work of mental
health professionals, about the tensions created by the dual
mandates for providing both care and custody, and about how mental
health care becomes subordinated to security and correctional
priorities. Using the theory and method of institutional
ethnography (Smith, 1987; 1990a; 1990b; 1998; 2005; 2006), the
provision of mental health care by frontline workers in a Canadian
prison-hospital was examined to make clear how routine forms of
policy have the capacity to control and mobilize the work of
frontline staff in a way that produces a power for the correctional
mandate of the prison-hospital, which subordinates the mental
health mandate (Dieleman Grass, 2010).
Correctional policies provide a conceptual
system of knowledge that produces power to move the correctional
mandate inevitably along. The dominance of this correctional
conceptual system is amplified by the lack of a comparable
conceptual system of vision for the mental health mandate within
the organization’s policy structure. Policies are understood to be
a central part of the social organization of forensic environments
and, as such, they exert a power generated through the concerting
and mobilization of the work of frontline staff. Understanding that
policy is an authoritative allocation of values, questions arise
about whose values are being legitimized, as well as what values
are absent from existing policies and through what processes.
Specific accountabilities for meeting the operational requirements
of a prison-hospital promote the ideas and values inherent in these
requirements. Organizational pressures to meet these requirements
create a sense of urgency and adjustments are made to ensure that
these requirements are met. Without a comparable set of operational
requirements for a prison-hospital, a similar
sense of urgency does not arise and operational adjustments are
made at the expense of mental health care.
There are opportunities for mental health
staff to participate in the policy process in ways that will bring
about positive change in their own work environment. These
opportunities manifest in a) the knowledge frontline staff have of
how to use and respond to the use of policies in ways that will
advance mental health care, b) the use of ethical standards to
identify and employ legitimate strategies and tactics in bargaining
and negotiation processes, and c) the renegotiation of conditions
that determine ‘wins’ or ‘losses’ for mental health care within the
Dieleman Grass, C. (2010). Slow
decline: The social organization of mental health care in a
prison-hospital. Unpublished doctoral dissertation, Queen’s
University, Kingston, Canada.
Smith, D. (1987). The everyday
world as problematic: A feminist sociology. Toronto:
University of Toronto Press.
Smith, D. (1990a). The conceptual
practices of power: A feminist sociology of knowledge.
Toronto: University of Toronto Press.
Smith, D. (1990b). Texts, facts and
femininity: Exploring the relations of ruling. London:
Smith, D. (1998). Writing the social:
Critique, theory, investigation. Toronto: University of
Smith, D. (2005). Institutional
ethnography: A sociology for people. Toronto: Altamira
Smith, D. (2006). Institutional
ethnography as practice. Toronto: Rowman & Littlefield