Dissertations – Clinical and institutional policies in mental health in France

Héloïse Haliday is currently working on a thesis that might be of interest to h-madness readers.

My PhD thesis studies the organization of mental health care in France as seen by the professionals. It thus focuses on the practices and representations of practice of all kinds of mental health professionals caring for people with mental health issues, under the title “Who cares for the network ? Clinical and institutional policies in mental health in France”.

Although French mental healthcare policies have changed in the last fifteen years, it seems the day-to-day issues the professionals are facing very much resemble those  of their 1960’s predecessors – how to deal with hierarchy in the services, how to build a sense of collectivity between patients and professionals, how to create a network of institutions and people caring for the patients in the city…-, meaning seemingly outdated paradigms still deserve to be studied. The paradigm I’m most interested in is institutional psychotherapy, a movement which was started in the 50’s by some of the clinicians who contributed to the French psychiatric revolution after WWII. My main assumption is that its core principles could still be useful in analyzing what is going on today in French mental health services, and my PhD research therefore aims at evaluating their relevance in understanding and improving the way today’s mental health professionals deal with the organization of their teams and networks. To do so, I first studied a corpus of books, journal articles and conference proceedings dating from the 50’s to the 90’s by the most famous authors of institutional psychotherapy (François Tosquelles, Jean Oury and many others) to extract eight “operators” – defined as operational concepts helping connect theory and practice – of institutional psychotherapy, which are :

  • A necessary distinction between a professional’s status, role and function
  • Considering the “therapeutic coefficient” of daily life
  • “Being-with” and doing things together with the patients
  • Scheduling different kinds of meetings to insure clinical decisions are made collectively
  • Freedom of circulation and freedom of speech
  • “Welcoming” as a collective function
  • Being careful to not let the professionals’ own psychological complexes alienate the patients and impair their treatments
  • –        “Grafting openness”, i.e. helping patients as well as institutions open to the community

I am currently analyzing the data I gathered from over 80 semi-directed interviews with varied professionals with these operators as a framework. I will then combine this thematic analysis to my observations to see if the professionals, consciously or not, use any of these operators in their practices and discourses to deal with the issues raised by day-to-day life with patients and colleagues in a mental health service.

Héloïse Haliday is a clinical psychologist and 3rd year contract PhD candidate at the Research Center in psychoanalysis, medicine and society. While teaching clinical psychology and the history of French psychiatry at the department of psychology and psychoanalytic studies of Sorbonne Paris Cité University, she’s recently been part the French Hospitals Federation’s “Quality of working life” commission, for which she wrote a literature review. She’s currently interested in the comparison of historical theories of workplace organization in psychiatry, like institutional psychotherapy, and newer management trends and models like Magnet Hospitals and agile healthcare.

Contact: heloise.haliday@gmail.com

The drawing is of a Cynodon Dactylon by the Instituto de Botánica Darwinion in Buenos Aires, Argentina. Héloïse uses it to illustrate Deleuze and Guattari’s Rhizome.

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