Anchoring practice in flux: Experiences among professionals in Norwegian specialized ambulatory mental health care teams

Abstract

This study investigates how mental health professionals working in Norwegian specialized ambulatory teams navigate complex ethical, relational, and organizational demands within fragmented care environments. Using an exploratory qualitative design, we conducted semi-structured focus group interviews with practitioners across 11 teams, including Assertive Community Treatment (ACT), acute, follow-up, and rehabilitation services. Reflexive thematic analysis yielded four interrelated themes: Anchoring Amid Chaos, Bearing Ethical Strain, Reinventing in Motion, and Sustaining Care Through Strong Relationships. These themes illustrate how professionals navigate fragmented systems by exercising moral judgment, building relational connections, improvising in real time, and coordinating informally across organizational divides. Theoretically framed by Zigon’s concept of moral breakdown, Rogers’ person-centered theory, Schön’s reflective practitioner model, Luhmann’s systems theory, and the PINCOM model of interprofessional collaboration, the study positions these practitioners as reflective mediators who uphold continuity and therapeutic integrity amid institutional fragmentation. While grounded in a specific regional context, the findings provide experience-near insights into the micro-practices that sustain recovery-oriented care within decentralized and unpredictable systems. The study highlights the need to support the anchoring role of frontline professionals by fostering ethical reflection, strengthening relational infrastructure, and enabling responsive collaboration across fragmented systems. These findings underscore the importance of recognizing the adaptive anchoring work among practitioners and offer concrete directions for training, evaluation, and policy in community-based mental health care.