Competing models of illness and healthcare
Conflicts between different agencies in multi-agency teams, although not invariable, are a familiar experience for everyone involved in community mental health care. Psychiatrists, psychologists, and social workers find themselves at odds over everyday issues of clinical management (Department of Health 1999a); community psychiatric nurses are caught in the cross-fire (Colombo, Bendelow, Fulford, and Williams 2003); and users of services (patients and carers) feel that their real needs are subordinate to the agendas of professionals and managers (Dunn 1999; Rogers and Pilgrim 1996). The result, all too often, is a failure of the collaborative decision making on which, as has been widely recognized (Department of Health 1999b), the effective delivery of community mental health services critically depends. The factors that encourage or frustrate collaboration within multi-agency teams (including patients and carers) are complex and not well understood. They include resource issues, professional rivalry, lack of training, and a host of other particulars. One factor, to which we believe relatively little attention has been paid, is unrecognized differences between agencies in their respective models of disorder. [Fulford and Colombo 2004: 129]
So begins a paper by the philosopher and psychiatrist Bill Fulford and the sociologist Tony Columbo. The idea is that different health professionals and service users have different conceptualisations or models of illness. If that is true it is no surprise that communication between different professions can be difficult. But what do Fulford and Colombo mean by 'model'?
Reading
Fulford, K.W.M. and Colombo, A. (2004) ‘Six Models of Mental Disorder: A Study Combining Linguistic-Analytic and Empirical Methods’ Philosophy, Psychiatry, & Psychology 11: 129-144