Robicquet Pierre

PHD Student in sociology, EHESS

Dissertation title: Role and boundary matters of public psychiatrists. Cross-study of professional and organisational dynamics in mental health

Dissertation under the direction of Maurice Cassier and Nicolas Henckes

The functioning of public psychiatry in France is based on the articulation of hospital services and outpatient structures, limited to a number of patients and circumscribed to a geographical area called a "sector". Each sector is part of a local network of actors from the health, medico-social and social sectors. Within this framework, care is conceived as a system designed to guarantee long-term follow-up of patients, and whose effectiveness is based on coordination between these actors. Since the 1990s, the evolution of public health under the influence of managerial logics, characterized by the control of costs and practices, the separation of steering and execution functions, or the use of market mechanisms, has raised a series of questions about the evolution of the role of the medical professions in psychiatry.

This study looks at the ways in which psychiatrists in the sector are affected by these dynamics and participate in the regulation of collective action in mental health. It is based on the premise that the adjustments and arbitrations made by psychiatrists cannot be reduced to a losing and head-on opposition with the central administration. Even though the classical model of professional autonomy may be weakened, it seems more fruitful to argue the existence of an interrelation between the recomposition of professions and public service institutions. I am interested in these recompositions in order to investigate, on the one hand, how work organisations stabilise and coordinate with each other in mental health and, on the other hand, to study the renewal of certain mechanisms of competition and professional segmentation.

To carry out this survey, I advocate the articulation of three main areas of work. The first one aims to document the design and reception of rules relating to the supervision of patient follow-up from the 2000s onwards, using interviews and archives. The second one, through interviews with psychiatrists, focuses on the study of careers and professional practices. The third and main project is a multi-site ethnography in a public hospital environment, focusing on the problematisation of social and medico-social support situations for patients. My interest in these operations can be justified because the institutionalisation of partnership networks directly questions the translation of the cited logics of public health governance. And on the other hand, because the resolution of these situations involves technical and organisational arbitrations that are potentially structural for professionals and whose forms are poorly documented.

Methodologically, I distinguish two kind of approaches : a situational approach, concerning analysis of decisions and professional relations, and a systemic approach, concerning analysis of the relations between the organisation of work and the structuring of professional and public institutions.