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Synopsis of Crystal Grass' doctoral research in prison-hospitals

Crystal Grass As 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.

Often, tensions experienced by frontline staff are assumed to be the result of ‘difficult people behaving badly’ or ‘not knowing or understanding their job’. In fact, these tensions reflect systematically organized ways of doing things within the organizational context. Without the values and objectives of mental health care being integrated into organizing policy structures, the social relations of everyday life are systematically organized to carry out purposes that do not fit with the mental health professionals’ own vision for mental health care. It is important to consider that failures of a mental health mandate are not necessarily the result of the structure of mental health policies but result from the interaction of all organizational policy structures that operate within and influence the day-to-day activities of the forensic environment. The causes of decline in mental health care often lay outside the relatively small areas upon which mental health policies are focused.

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 correctional context.



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: Routledge.

Smith, D. (1998). Writing the social: Critique, theory, investigation. Toronto: University of Toronto Press.

Smith, D. (2005). Institutional ethnography: A sociology for people.  Toronto: Altamira Press.

Smith, D. (2006). Institutional ethnography as practice. Toronto: Rowman & Littlefield Publishers.