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This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trust’s adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named “Handling Role Boundaries”, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how “mental health difficulties” are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination.

Joint replacement is a cost-effective and efficient method of relieving pain, and improving function and health related quality of life, for people with arthritis of the hip and knee [1]. Arthritis-related loss of physical function is associated with unemployment, reduced income and increased sickness absence [2]. In a survey investigating the impact of osteoarthritis (OA), Fautrel et al found that OA has a substantial impact on work, with 20% of patients surveyed still in the workforce and two thirds of those reporting that OA was affecting their work [3]. These factors, in combination with an ageing workforce and changes to the pension age, have resulted in an increase in the number of hip and knee replacements carried out on people of working age over the past ten years. In 2015, 17,293 of 84,462 (20%) hip replacements and 16,121 of 94,437 (17%) knee replacements performed in England, Wales and Northern Ireland were in people aged under 60 years; 25,249 (30%) hip replacements and 32,321 (34%) knee replacements were performed on inpatients aged between 60-69 years [4]. Projections from 2005 suggest that by 2030, the demand for primary total hip (THR) and knee (TKR) replacements will increase by 174% and 673% respectively [5].Consequently return to work (RTW) will be a priority for an increasing proportion of the population following surgery.

My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a “Single Point of Access” meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named “Handling Role Boundaries,” highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an “ABCD” format.

Background: Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial. Method: Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees. Findings: A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing. Conclusion: Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust.

Background: Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial. Method: Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees. Findings: A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing. Conclusion: Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust.

My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a “Single Point of Access” meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named “Handling Role Boundaries,” highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an “ABCD” format.

This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trust’s adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named “Handling Role Boundaries”, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how “mental health difficulties” are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination.

My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a “Single Point of Access” meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named “Handling Role Boundaries,” highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an “ABCD” format.

This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trust’s adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named “Handling Role Boundaries”, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how “mental health difficulties” are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination.

This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trust’s adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named “Handling Role Boundaries”, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how “mental health difficulties” are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination.

My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a “Single Point of Access” meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named “Handling Role Boundaries,” highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an “ABCD” format.

Background: Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial. Method: Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees. Findings: A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing. Conclusion: Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust.

My PhD study which began in 2009 focused on the decision-making behaviors of mental health professionals, as they attended a “Single Point of Access” meeting. These meetings are set in community mental health services and involve professionals from an array of professional backgrounds discussing client cases, based on received letters from general practitioners. The general practitioners write these letters seeking advice and direction as to which mental health services the client should be sent to, in response to their needs. On occasions, some general practitioner letters are addressed to a specific person attending the meeting; at other times, they are addressed generally to the whole team. The Single Point of Access meetings house community mental health team members and representatives from more specialized services. The business and interactions of this collection of multidisciplinary professionals provided a useful opportunity to apply a classical grounded theory approach. With Single Point of Access meetings being relatively new at the time of study, discovering, describing, and conceptualizing the decision-making process inherent in these meetings were exciting prospects. After 4 years of study, I produced a grounded theory from my data collection and analysis, which was named “Handling Role Boundaries,” highlighting how these professionals manage and work with multiple roles to bring out the strength of the team and expedite the decision-making process. This case study conveys my personal journey from copious data to Handling Role Boundaries. I present the journey as a learning process, denoted in an “ABCD” format.

This ESRC funded CASE studentship PhD project provides a comprehensive investigation into the referral allocation process within an NHS Trust’s adult mental health facilities, known as Single Point of Access (SPA) meetings. These meetings provide a multidisciplinary environment in which mental health practitioners consider client referrals in the form of letters from, primarily, General Practitioners (GPs) and direct them to appropriate services and interventions. Participants in these meetings can be seen as gatekeepers authorising access to other mental health services. The study was formally identified by NHS Research Ethics procedures as a service evaluation. From an academic perspective it is sociological research heavily informed by Glaserian Grounded Theory (GT) methodology. This approach has uncovered an internal Basic Social Process (BSP) underpinning SPA meetings. It has been named “Handling Role Boundaries”, and it describes how SPA meeting attendees endeavour to work together as they make crucial decisions about clients. Initial research plans included the collection and evaluation of quantitative data which would assess the relative validity of SPA meeting decisions. Unfortunately the quality of available data proved insufficient for this purpose. This provided brief insight into tensions between administrative systems and the real life mechanisms of SPA meetings. Overall, the unfulfilled evaluative purposes of the study provided an opportunity to focus more on clarifying the BSP underpinning SPA meetings. Also explored is how this BSP has wider implications for an understanding of how “mental health difficulties” are framed and provided for. The thesis concludes that Handling Role Boundaries is a highly innovative theory offering major contributions to understanding one social space of mental health professionals. Furthermore, it offers plentiful scope for further research and will be appropriate for many avenues of dissemination.