Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit Saario S, Raitakari S. Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit Int J Soc Welfare 2010: 19: 321–329 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. Mental health NGOs in Western Europe are increasingly managed by contractual audit procedures. This article con- cerns how contractual audit and its emphasis on effectiveness of care impact on the practices of long-term mental health rehabilitation. To demonstrate this, a case study of a Finnish NGO that provides supported housing is presented. The study looks at how service purchasing practices, as stated in the contract between the municipality and the NGO, are reflected in the meetings among practitioners. Documentary and meeting data were utilised together with Mitchell Dean’s notion of technologies of agency. It was found that practitio- ners actively sought to show the effectiveness of their every- day work in terms of contractual audit by demonstrating both the economic and progressive aspects of care. Thus, profes- sional competency in mental health rehabilitation appears to entail both the skills of care interventions and the ability to perform these interventions as efficient and financially accountable activities. Sirpa Saario, Suvi Raitakari Department of Social Work Research, University of Tampere, Finland Key words: contractual audit, effectiveness, mental health reha- bilitation, NGO, technologies of agency, Finland Sirpa Saario, Department of Social Work Research, 33014 University of Tampere, Finland E-mail: sirpa.saario@uta.fi Accepted for publication January 24, 2010 Introduction In Western welfare states, reforms of management models in the social and health services have often been implemented according to the principles of new public management. 1 In the service structure based on these principles, practitioners in social and health services are increasingly expected to provide evidence of the effectiveness of their practice and embrace an effective work orientation (Germov, 2005; Joyce, 2001; Juhila 2006). Within these demands, the dilemma between the practitioners’ professional autonomy and their compliance with administrative and market principles has been widely acknowledged (Banks, 2004; Joyce, 2001; Lipsky, 1980; Prottas, 1979; Sawyer, 2005, 2006). According to Rajavaara (2007), the practices related to evaluating effectiveness have been wide- spread also in Finnish social policy and the governance of the welfare state since the late 1980s. This article looks at a Supported Housing Unit (from now on referred to as the Unit), which provides long- term mental health rehabilitation and holds a position as a service provider within a local purchaser–provider model that applies the principles of new public man- agement. The actors of the model include the municipal purchaser of services and several competing providers, the latter being evaluated on the basis of the economic efficiency, on the one hand, and the perceptible results, on the other. To be worth funding, long-term rehabili- tation and its results have to be made visible in a way that the purchasing party accepts. This kind of market- orientated situation is a new one for the Unit, which previously was managed by administrative steering and 1 New public management (NPM) is not a homogeneous system, but rather a plurality of ideas and objectives based on neo-liberalism. The central aspect of NPM is that the prob- lems of public management will be solved as soon as actors embrace the modes of operation of commercial organisa- tions, and, instead of the excessive expenditure of bureau- cratic mode of activity, strengthen the role of markets as a steering mechanism (see Clarke & Newman, 1997; Dean, 1999, 2007; Greve & Jespersen, 1999). DOI: 10.1111/j.1468-2397.2010.00726.x Int J Soc Welfare 2010: 19: 321–329 INTERNATIONAL JOURNAL OF SOCIAL WELFARE ISSN 1369-6866 © 2010 The Author(s) Journal compilation © 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA 321