Categorising to exclude: the discursive construction of cases in community mental health teams

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Abstract
This paper examines meetings in which community mental health teams (CMHTs) process referrals from psychiatrists and GPs, to determine whether or not patients should be ‘allocated’ to caseloads. It focuses on the discursive construction of cases, and the way in which some patients are marked out as inappropriate referrals in a process of implicit categorisation that avoids open reference to pejorative or exclusionary labels. While team members do not present their actions as ‘rationing’, references to inappropriateness occur in close proximity to references to resource pressures and claims that referrals are not subject to proper ‘gatekeeping’. Staff may channel such patients towards less intensive treatment options, request more information to delay acceptance on to caseloads, or reject referrals as inappropriate. Thus the care offered to patients not defined as ‘seriously mentally ill’, but referred in the belief that they could benefit from CMHT input, was subject to de facto rationing.

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