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Understanding How Case Managers Use 'Sabotage' as a Frame for Clinically Difficult Situations.

Victoria Stanhope1, Emmy Tiderington1, Benjamin Henwood1

  • 1Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003-6654, USA.

Clinical Social Work Journal
|August 11, 2025
PubMed
Summary
This summary is machine-generated.

Case managers perceive "sabotage" in severe mental illness care as stemming from service users' fear of success, avoidance of change, and insufficient support, impacting engagement. This understanding can improve interventions and reduce service disengagement.

Keywords:
Adults with severe mental illnessesCase managementCommunity based mental health servicesHousingQualitative research

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Area of Science:

  • Mental Health Services Research
  • Clinical Psychology
  • Psychiatric Case Management

Background:

  • Case managers are crucial for engaging individuals with severe mental illnesses.
  • Understanding case manager perspectives on difficult situations can reduce service disengagement.

Purpose of the Study:

  • To explore how case managers interpret and respond to clinically difficult situations, specifically when they use the term "sabotage" to describe service user behavior.

Main Methods:

  • Qualitative study involving interviews with 21 case managers.
  • Co-coding analysis focused on the application of the term "sabotage".

Main Results:

  • Case managers attributed "sabotage" to service users' fear of success or desire fulfillment.
  • Avoidance of responsibility and change, and lack of structured support were also identified as reasons.
  • Themes highlight the complex dynamics in managing severe mental illness.

Conclusions:

  • Findings offer insights into improving case manager training and supervision.
  • Service structure adjustments may be necessary to address perceived "sabotage" and enhance mental health recovery.
  • Interventions should consider the underlying reasons for behaviors labeled as "sabotage".