Organisational defences revisited: Systems and contexts

It has been suggested that localised attempts at change may fail because of organisational defences that are sustained through bureaucratic systems. Mental health workers face specific threats arising from the nature and context of their work. The resulting anxieties lead to defensiveness in the workers that may be supported by organisational structures and procedures. Attempts at changing existing patterns of work can increase anxiety and lead to more (rather than less) entrenched resistance in the form of organisational defences. As a result, the service received by patients may barely change. Four health service contexts are introduced here and psychodynamic processes operating therein are explored and contrasted.