Role confusion, values-based practice and the demise of the generalist

Whatever happened to the generalist? Healthcare has become increasingly specialised over past decades yet surprisingly little has been written about the demise of generalism in mental health for example, it gets very little attention in the New Ways of Working documentation (Royal College of Psychiatrists et al, 2005). The roles of generalist and specialist have a reciprocal relationship to one another. This article is an attempt to respect (literally to ‘look again’ at) the idea of generalism as a role (or set of roles). First, roles will be defined as forms of enacted values and then further considered as values that often exist in tension with one another. An example of a value tension is when a service user’s need to be protected (because of the consequences of having a mental disorder) comes into conflict with their therapeutic need for personal autonomy and development.We could summarise this tension as safety v. growth. This article will explore how this sort of tension can get unhelpfully acted out systemically when the generalist role gets lost within multidisciplinary teams whose specialist members may have different attitudes to treatment approaches (Lepping et al, 2004).