Decision-making processes within mental healthcare

An ethnographic study of the spaces of action, dilemmas and discrepancies within mental healthcare for dually diagnosed persons


The aim of the project is to explore how different political, professional and institutional guidelines and ideals as well as personal values and rationalities frame the decision-making processes, priorities and negotiations within the mental healthcare for dually diagnosed persons. The hope is to obtain extended knowledge about the spaces of action, dilemmas and discrepancies, which dually diagnosed persons, their relatives, and the professionals involved, face, in order to contribute to ease and qualify the decision-making processes within the mental healthcare system.


In Denmark, dually diagnosed persons – e.g., persons who are diagnosed with both a mental health disorder and a substance use disorder – make up one of the most marginalized and valuable groups within the Danish society and one of the most complex patient groups within the Danish healthcare system, and more specifically the mental healthcare system. Even though up to 50 percent of all persons who use psychiatric services also have a problematic use alcohol and/or drugs they rarely receive the help they need. Thus, it seems that the so-called recovery-orientation, which has constituted a common professional as well as political ideal and been the foundation for decision-making and action within the mental healthcare system and modern rehabilitation practices for the last decades, has not had the desired impact on the treatment of dually diagnosed persons. Instead, dually diagnosed persons often end up being thrown around, between the regional psychiatric treatment and the municipal substance use treatment, each with its own professional and political focus, while at the same time, the relatives have their own individual perceptions of what kind of treatment and care is needed, which do not necessarily correspond to neither the professionals’ nor the users’.

The Study

The study adopts a qualitative and an ethnographic approach based on six months of ethnographic fieldwork using qualitative interviews and participant observation among dually diagnosed persons, their relatives and professionals. Hereby the project aims to explore, how different standards, guidelines, ideals, values and rationalities are enacted, prioritized, and negotiated in the specific decision-making within practice. Additionally, the study will consists of a policy analysis of currently applied national and local policies within the field in order to identify how the ideal psychiatric and substance use treatment is presented and to explore what spaces of action, dilemmas and discrepancies this creates in relation to the specific decision-making practice and mental healthcare for dual diagnosed persons.

The project will take place from September 2020 to September 2023