Responding to mental health crisis at a street level: mental health practitioners as street level bureaucrats

Street triage practitioners, consisting of mental health social workers and nurses, act as a conduit between service users and emergency services and have a significant amount of discretion in determining the care and treatment pathways for individuals experiencing mental health crises. However, this is set on a backdrop of neoliberal reforms which have resulted in an increased focus on risk management, accountability, responsibilisation, and managing scarce resources. Based on ethnographic research undertaken in a street triage setting in England, this paper examines the role of street triage practitioners as ‘street level bureaucrats’ and explores the impact of neoliberal mental health reforms on street level practice and how these shape and constrain the use of discretion in a street triage context. Revisiting the relevance of Lipsky through a neoliberal lens, the research paper identifies how street triage practitioners use their discretion to navigate practice dilemmas in a contemporary mental health landscape.