Reorganizing modes of action in community child and adolescent psychiatry
Université Paris V - René Descartes - Faculté de sciences humaines et sociales CESAMES (Centre de Recherche Psychotropes, Santé mentale et Société ? CNRS UMR 8136, INSERM U611, Paris 5) FRANCE,
In less than one half-century, french psychiatry has undergone deep institutionnals transformations. Since the sixties, the vertical logic which characterized the closed institution has become horizontal with the multiplication of services in the community. In the last fifteen years, mental health and psychic suffering in teenagers and young adults have become major social issues. To adress them, new public policies (since 1990) were designed which redefine psychiatry?s perimeter of action. The aim of this thesis is to analyse these transformations in France, where very few studies by social sciences exist. The hypothesis is that new public policies of mental health and psychic suffering in teenagers (and young adults) operates a reconfiguration of action in mental health and psychiatry (and not a psychologisation of social problems according to the theory of social control), in two mains directions : first, the system of action in mental health implies a multiplicity of professionnals and institutions who have no used to work together, until short while ; second, the action in psychiatry turn towards autonomy (self-governement, and not social control, moralisation or emancipation in accordance with educational ideal until sixties in disciplinary society) by accompaniment of personnal trajectories and developpement of capabilities (empowerment). It is examined through the analysis of national and local public policies, of the lines of tensions that they create among professionals, and of how they reframe action and its modes. I propose to present the mains results of this research and to develop one aspect like adjustements of action in community psychiatry concerning teenagers far away from mental health institutions (and professionals), without demand of care, and for which the face to face meeting is not adapted. The analysis of the speeches of professionals of psychiatrie and their partners shows that two mains registers of action are invested by the actors. The first one is situated beetween ?to make with? teenagers without demand of care and ?arouse to make (it)? ; the second register consists ?to make with? the circle of acquaintances, professional or family, of the teenager rather than ?make nothing? with teenagers remote from institutions of care.