The French welfare state revisited: the puzzling politics of mental health policy
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The French welfare state revisited: the puzzling politics of mental health policy Isabel M. Perera1 Accepted: 23 September 2020 © Springer Nature Limited 2020
Abstract The logic of French mental health policy—which already stands out against that of other countries—also appears at odds with the usual logic of French social policy. “La sectorisation psychiatrique” rejected the liberalism prominent in the rest of the health system, adopted Beveridgean principles decades in advance of other policy areas, and began to centralize precisely during the period of déconcentration. This article explains these puzzles by pointing to the role of public sector trade unions. Archival sources document how the historical advocacy of unions representing public psychiatric workers shaped public policy in mental health. Examining their political activity can revise standard interpretations of the French welfare state and illuminate a generalizable theoretical relationship for comparative analysis. Keywords France · Welfare state · Mental health policy · Sectorisation psychiatrique · Public sector · Trade unions By and large, the study of the French welfare state has excluded mental health. This absence may surprise some observers, particularly those familiar with the long line of francophone social theorists who analyzed psychiatry (e.g., Foucault, Deleuze, Guattari, Fanon). Yet despite the prominent intellectual history of French psychiatric and social thought, little attention has been paid to the political and economic logics that underpin the mental health system in France. The neglect is unfortunate for two reasons. First, the story of mental health policy in France differs from that found in Anglo-American countries, which have set international expectations in this policy area. Although the rapid closure of psychiatric hospitals in the late twentieth century resulted in the mass displacement of people with mental illnesses in other countries,
* Isabel M. Perera [email protected] 1
Department of Government, Cornell University, White Hall, Ithaca, NY 14850, USA Vol.:(0123456789)
I. M. Perera
France did not experience this trend. Second, and perhaps more surprisingly, the underlying logic of the psychiatric system differs from the general principles and patterns that guide the French welfare state and its social policies.1 Although private healthcare providers, employment-based social protection, and a shift toward administrative decentralization have become cornerstones of the French welfare state, the mental health system has opted for just the opposite: public health care provision, citizenship-based social protection, and centralized administration. A general familiarity with welfare in France, therefore, provides a limited, and even misleading, understanding of the mental health system. This article traces the development of mental health policy in France by evaluating primary sources (government and advocacy documents relating to mental health policy from the mid-nineteenth to the late twentieth centurie
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