How do approaches to management affect knowledge and patient care? In this paper, the establishment and dismantling of an organisational unit for research and development (R&D) in a mental health department of a Norwegian health enterprise are analysed. The characteristics of two adverse treatment ideologies and their coherence with approaches to organisation and management are outlined and discussed on the basis of the change process. During the period of the study change, management increasingly turned towards being more top-down, analytical and systemic. This caused a weakening of recognition of new, contextually and relationally informed professional approaches to knowledge and treatment. Furthermore, this entailed restrictions in relational processes involving development, research, knowledge and collaboration, something which might have skewed professional approaches in the direction of treatment and care founded on evidence-based medicine and practice. (Contains 1 table and 2 notes.)