Clients or patients? The construction of everyday work with substance misusing pregnant clients at a Finnish maternity clinic

The field of Finnish substance abuse services has undergone many significant changes in the last decade due to structural changes in the society and its welfare policies and services. These changes include e.g. a shift from a rather unique “social model” of services towards a more “medical model”, a new understanding of the service users as consumers and clients and a new political emphasis on reducing the harms of drug use. These changes have affected also the everyday work of Finnish health and social professionals working in the field of substance abuse services.

In this paper I will look at the construction of everyday work of health and social professionals at an outpatient maternity clinic that provides specialised services to pregnant women with problematic alcohol or drug use. The analysis draws on Erving Goffman’s concepts institutional front and back stages. The professionals’ everyday work takes place in a twofold framework of front stage activities where the professionals encounter the service users in “client-centred” and morally neutral terms and back stage activities where the professionals discuss in moral terms their clients’ problems and ability to be good mothers. At the back stage the clients are discussed in a manner that gives them the role of passive patients whereas at front stages they are treated as client-consumers who are experts of their own life. The front and back stages are constructed in the course of everyday institutional interaction but I will argue that the professional “double discourse” evident in the formation of the two stages also reflects more general structural trends in today’s Finnish society and its welfare policies and services.

This study is a part of my ongoing PhD research and the data consists of interviews with the clinic’s staff and ethnographic notes written during six months of conducting participant observation at the clinic.