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Briggs, A. (2019). Low Morale and the Loss of Clinical Identity and Leadership: An Outcome of Suppressed Turbulence in Modern CAMHS. Organ. Soc. Dyn., 19(1):61-80.

(2019). Organizational and Social Dynamics, 19(1):61-80

Low Morale and the Loss of Clinical Identity and Leadership: An Outcome of Suppressed Turbulence in Modern CAMHS

Andrew Briggs

This article examines the relationship between the National Health Service (NHS) internal market and Child and Adolescent Mental Health Services (CAMHS) in England and Wales. This relationship is the conduit for turbulence passing from the former to the latter. This turbulence is created by the manifest and latent content of the internal market outcomes for senior managers involved in this market's tendering process. Manifestly the outcome for them is winning or losing contracts to provide services, resulting in either keeping or losing their jobs. The latent content is the activation of what Freud termed the life and death instincts. With these instincts stirred within senior managers, keen to ensure they do not lose the contract to provide services when the tendering process next is implemented by NHS commissioners, the death instinct is projected into clinicians through the design of service delivery models and structures. These models aim to ensure the minimum risk to the CAMHS organisation as a competitive business. In order to achieve this clinical leadership is removed from service design and delivery. What is designed removes the need to apprehend the meaning of patients' symptoms and instates the need only to risk assess and manage them. This is turbulence suppressed, resulting in low staff morale through the loss of clinical identity, clinical leadership, and the introduction of meaninglessness to clinical life.

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