On the old and the new: An ethnographic study of older people’s mental health services in a changing welfare state

The Norwegian welfare state is traditionally known as universalistic. Thus, it might be expected that public healthcare services would cover all citizens on equal terms. Yet older people with mental health problems are not covered in this way. Their mental health problems are described as under-treated. The access of older people to mental health services is perceived as being inferior to that of younger people. Finally, elderly care is characterised by an increasing tendency to downplay the psychosocial dimensions of care. Paradoxically, these non-universalistic outcomes result from patterns of action that are informed by universalistic belief. Part of this belief is a tendency among variously positioned welfare state stakeholders in Norway to place trust in the state and its capacity and determination to carry out a policy of universalistic welfare. Trust in the state as a universalistic enabler occurs in a setting where the Norwegian welfare state experiences a financial capacity problem. Moreover, it occurs in an international setting where welfare states are converging. One of the consequences is that universalistic welfare states are liberalized. This thesis argues that in this national and international setting, the state exploits its power over the municipalities in order to avoid blame and shirk responsibility for policies with non-universalistic outcomes. Universalistic belief encourages municipal stakeholders to accept the role as scapegoat for national, non-universalistic policies, and to act in ways that perpetuate such policies. It is probable that the mental health field of older people is just one illustration of a general development of universalistic decline which is likely to become widespread. Universalistic decline is accompanied by gradual change in traditional Norwegian beliefs which are being replaced by new ones