Att använda resurserna rätt… Primärvårdskuratorers handlingsutrymme vid sjukskrivning av patienter med psykisk ohälsa

Sammanfattning: The aim of this study was to explore how primary care social workers discuss their professional role and discretion in relation to considerations of sick leave for patients with mental illness, thereby deepening the understanding for how consultation and informal decision processes manifest between social workers and doctors working within the same organisation. Qualitative semi-structured interviews were conducted with eight primary care social workers, from five different municipalities in the region of Skåne. During analysis the following theoretical approaches were applied to the results; Lipsky (1980/2010) and Molander (2011; 2016) theories of ‘street-level bureaucrats and professional discretion, Liljegren (2008) theory about professional boundary work and finally Abbot (1988) theory of professional jurisdiction. Four themes were identified during analysis: social workers lack of formal mandate during the sick leave process, social workers informal mandate in initial assessment, acting as a red flag during the sick leave process and conditions for communication at the workplace. The results of this study showed that primary care social workers despite lacking a formal mandate, can influence decisions made during the sick leave process by way of their professional discretion. Primary care social workers as part of psychosocial care teams were primarily able to influence doctors’ considerations of sick leave by way of their initial assessments and flagging the doctor when there was a need for action. A general lack of time and space for communication with doctors was found to be one of the primary factors limiting social workers use of discretion to influence the sick leave process. This study attempts to highlight primary care social workers contributions during the sick leave process in terms of psychosocial assessments that contextualize the patient’s health situation and preventive work in relation to mental illness within the primary health care system.