Delayed discharges in the chainsaw era: Clashing social values and the challenges to psychiatric reform in Argentina

Abstract

Social values are central to understanding how health systems operate and the rationale behind their transformation. This work examines how the values associated with psychiatric reform and the transition from institutional to community-based mental health care are mobilized in delayed discharges in Argentina’s general hospitals, amid a political context marked by policies centered on fiscal austerity and public spending cuts. Drawing on interviews conducted in 55 general hospitals nationwide with public-sector mental health workers, the study analyzes tensions among three social values derived from the Latin American Psychiatric Reform framework: dignity and rights, technical rationality and community-based living. Findings reveal seven components shaping whether delayed discharges are considered justified or unacceptable. Five components frame delays as justified: structural shortcomings in community services, limitations in family support networks, the holistic nature of care, the hospital’s role as a care-providing institution, and internal tensions surrounding standardized care. Two additional components frame delays as unacceptable: pressures related to bed management and inadequate infrastructure, particularly from the standpoint of technical rationality and patients’ dignity and rights. The study shows that delayed discharges operate as a site of value-based tension within the public health system, reflecting broader struggles over care, responsibility, and resource allocation. In the current Argentine context of State retrenchment, these findings highlight the need to understand delayed discharges not only as an organizational inefficiency, but as a health systems problem shaped by complex and competing social values.