Background:Meetings are essential events for the production of a policy. Yet they are largely taken for granted in policy studies: they are perceived as tools for achieving predefined tasks and used as a means of studying other topics, such as public participation. Aims and objectives:I aim to study meetings themselves and to develop the concept of meeting in brackets, which helps understand how meetings produce the policy to which they relate. I focus on a Belgian mental health policy supporting a shift from hospital to community mental healthcare. Methods:Qualitative methods, including direct observation of 77 meetings and interviews, were combined over an eight-year period in order to comprehensively understand the relationship between meetings and policy production. Findings:The Belgian mental health policy gradually emerged from meetings that took place at international, national and local levels. As a result of references made by the participants to previous meetings or to the resulting documents, these meetings gradually formed a web, outside of which the Belgian mental health policy cannot be understood. Discussion and conclusions:The concept of meeting in brackets led to define meetings as communicative events framed by decisions about meeting structure, which I call bracketing decisions. These decisions facilitate a form of communication described as reflexive. Reflexive communication in turn leads to a collective creation: a unique vision of the policy under discussion. Such unique visions are gradually assembled as meetings succeed each other, thus forming a web of meetings which is inherent to policy production.
In this presentation, I suggest studying "the meetings" for themselves, by considering them as a topic for research and not as tool for doing researches on other topics as problem-solving and policy-making. By drawing on a sociological research on a Belgian reform of mental healthcare delivery, I argue that the concept of bracketing might be used to identify the forms and to analyse the various roles played by meetings, or what the meetings do to the organisational and policy work.
My PhD thesis related the growth of a large social system devoted to the treatment of personal problems; i.e. problems successively labelled as madness, mental illness and mental health problems, from the early fifties to the present days. That system involved heterogeneous networks of actors, including scientific experts, established professions, social movements, policy makers, services users and international organisations; instruments and knowledge ranging from psychoanalytical theories to biological knowledge and models of governance. It meant to explain how institutional change happened in that complex social system, by studying past and ongoing reforms, considered as interrelated steps towards complete paradigm shift, including shifting policy means, policy objectives and social organisation. By relying on in-depth analyses of five past reforms, it conceptualised the system as composed of interrelated ecologies, corresponding to different kinds of knowledge of personal problems, whose development was directed by protective and expansion strategies used by two coalitions of actors, holding different kinds of resources to influence the change process. The traditional coalition was embedded in the Belgian institutional system; it referred to medical knowledge of personal problems; and held many institutions delivering residential treatments. By contrast, the reformist coalition was connected to international professional and policy networks stimulating change in OECD-mental health systems; it referred to practical knowledge of social psychiatry and evidence produced by international organisations as the World Health Organisation; and it held non-profit associations delivering community treatments. Cross-regulations exerted through joint-participation of those coalitions in successive reforms caused rapid changes in the system's structural configuration while hindering change in its social organisation. Thus, we suggested thinking of the issue of change in the system as consisting in setting conditions in which the reformist coalition might extensively use its resources in conducting a new reform starting in 2010. By relying on that assumption, I presented three case studies analysing the devising of that reform at the policy level and its implementing through local networks. Those case studies drew attention to the kinds of knowledge used by key actors and to the way in which they used it in joint-attempts to take the leadership of the reform. Three main findings resulted from those case studies. First, the designing of the policy guide framing the reform consisted in assembling different kinds of knowledge together, including policy learning achieved through past changes in the system and knowledge of alternative care models implemented in OECD-countries, in a way that encouraged sustained enactments of knowledge specific to the reformist coalition, while decreasing the relevance of resources specific to the traditional coalition. Second, local meetings caused by the implementing of the reform enabled adaptations of knowledge embodied by the participants, i.e. multiple actors representing different ecologies and members of one of the two coalitions, to enacted knowledge, i.e. knowledge collectively produced by thinking about concrete means to implement the reform locally. Third, enacted knowledge caused, in turn, adaptations of the care model inscribed in the policy guide to local particularities. Those adaptations did not prevent, however, the global philosophy of the new reform, inspired by social psychiatry, from pervading in local networks, among other by being inscribed in operational documents resulting from meetings. Thus, by following the policy guide through local networks where it was translated into concrete practices, I have been able to indicate new directions in the global process of change in the system, towards a complete paradigm shift, from medical to social psychiatry, and to highlight social and learning processes making it possible.
Cette contribution porte sur les enjeux que soulève la réforme des soins de santé mentale en Belgique, au carrefour de l'évolution socio-historique du secteur, et d'un modèle des soins inscrit au sein de tendances internationales. Précisément, l'objectif est de mettre en tension l'indétermination du modèle, au sens où il renvoie à un ensemble d'expériences étrangères plus qu'un un corpus de savoirs; et la configuration d'une offre de soins encore déterminée par ses frontières institutionnelles.
Dans cet article, nous racontons une histoire relative au lancement et à l'installation d'une politique belge de santé mentale lancée en 2010. L'histoire s'articule autour de trois réunions partiellement fictives et re- constituées, dans une logique d'idéaltype, à partir de l'observation directe de plus de septante réunions dont elles résument les caractéristiques principales. Ces trois réunions se déroulent dans le monde politique, le monde professionnel et organisationnel, et le monde sensible représen- té par les « lieux du lien ». L'histoire vise à reconnecter ces mondes qui, dans la réalité, sont séparés par des divisions fonctionnelles et culturelles.
Dans cet article, nous racontons une histoire relative au lancement et à l'installation d'une politique belge de santé mentale lancée en 2010. L'histoire s'articule autour de trois réunions partiellement fictives et re- constituées, dans une logique d'idéaltype, à partir de l'observation directe de plus de septante réunions dont elles résument les caractéristiques principales. Ces trois réunions se déroulent dans le monde politique, le monde professionnel et organisationnel, et le monde sensible représen- té par les « lieux du lien ». L'histoire vise à reconnecter ces mondes qui, dans la réalité, sont séparés par des divisions fonctionnelles et culturelles.
Coordination is described as a widespread function emerging in relation to policy plans inducing collaboration between different sectors, organizations and professions. This paper suggests seeing the implementation phase as a translation process, one where the content of policy plans is reinvented primarily through discussion rather than linearly transferred from the political to the professional arena. It focuses on the function of coordinator with a view to examining how this function is performed and questions its influence on the local translation of both policy plans. The data collection was part of two research projects focusing on the reform of Belgian mental healthcare and the creation of care pathways for forensic patients, combining document analysis, interviews (n = 82) and observations (n = 58). The results highlight the inherent ambiguity of the coordinators' working environment, the socially-disputed nature of their function and define the coordinators as connection-makers who exert power over processes rather than people or structures. It demonstrates that coordinators influence the policy process by inducing discussions at meetings and the documents subsequently produced. In conclusion, this paper defines coordinators as process managers whose work largely consists of translating policy plans through event connectivity and contextualizing practices. Given the importance of translation in policy implementation, this paper calls for a reconsideration of policy evaluation as well as of the coordinators' recruitment and training procedures.
Coordination is described as a widespread function emerging in relation to policy plans inducing collaboration between different sectors, organizations and professions. This paper suggests seeing the implementation phase as a translation process, one where the content of policy plans is reinvented primarily through discussion rather than linearly transferred from the political to the professional arena. It focuses on the function of coordinator with a view to examining how this function is performed and questions its influence on the local translation of both policy plans. The data collection was part of two research projects focusing on the reform of Belgian mental healthcare and the creation of care pathways for forensic patients, combining document analysis, interviews (n = 82) and observations (n = 58). The results highlight the inherent ambiguity of the coordinators' working environment, the socially-disputed nature of their function and define the coordinators as connection-makers who exert power over processes rather than people or structures. It demonstrates that coordinators influence the policy process by inducing discussions at meetings and the documents subsequently produced. In conclusion, this paper defines coordinators as process managers whose work largely consists of translating policy plans through event connectivity and contextualizing practices. Given the importance of translation in policy implementation, this paper calls for a reconsideration of policy evaluation as well as of the coordinators' recruitment and training procedures.
Coordination is described as a widespread function emerging in relation to policy plans inducing collaboration between different sectors, organizations and professions. This paper suggests seeing the implementation phase as a translation process, one where the content of policy plans is reinvented primarily through discussion rather than linearly transferred from the political to the professional arena. It focuses on the function of coordinator with a view to examining how this function is performed and questions its influence on the local translation of both policy plans. The data collection was part of two research projects focusing on the reform of Belgian mental healthcare and the creation of care pathways for forensic patients, combining document analysis, interviews (n = 82) and observations (n = 58). The results highlight the inherent ambiguity of the coordinators' working environment, the socially-disputed nature of their function and define the coordinators as connection-makers who exert power over processes rather than people or structures. It demonstrates that coordinators influence the policy process by inducing discussions at meetings and the documents subsequently produced. In conclusion, this paper defines coordinators as process managers whose work largely consists of translating policy plans through event connectivity and contextualizing practices. Given the importance of translation in policy implementation, this paper calls for a reconsideration of policy evaluation as well as of the coordinators' recruitment and training procedures. ; Peer reviewed
Coordination is described as a widespread function emerging in relation to policy plans inducing collaboration between different sectors, organizations and professions. This paper suggests seeing the implementation phase as a translation process, one where the content of policy plans is reinvented primarily through discussion rather than linearly transferred from the political to the professional arena. It focuses on the function of coordinator with a view to examining how this function is performed and questions its influence on the local translation of both policy plans. The data collection was part of two research projects focusing on the reform of Belgian mental healthcare and the creation of care pathways for forensic patients, combining document analysis, interviews (n = 82) and observations (n = 58). The results highlight the inherent ambiguity of the coordinators' working environment, the socially-disputed nature of their function and define the coordinators as connection-makers who exert power over processes rather than people or structures. It demonstrates that coordinators influence the policy process by inducing discussions at meetings and the documents subsequently produced. In conclusion, this paper defines coordinators as process managers whose work largely consists of translating policy plans through event connectivity and contextualizing practices. Given the importance of translation in policy implementation, this paper calls for a reconsideration of policy evaluation as well as of the coordinators' recruitment and training procedures.
Coordination is described as a widespread function emerging in relation to policy plans inducing collaboration between different sectors, organizations and professions. This paper suggests seeing the implementation phase as a translation process, one where the content of policy plans is reinvented primarily through discussion rather than linearly transferred from the political to the professional arena. It focuses on the function of coordinator with a view to examining how this function is performed and questions its influence on the local translation of both policy plans. The data collection was part of two research projects focusing on the reform of Belgian mental healthcare and the creation of care pathways for forensic patients, combining document analysis, interviews (n = 82) and observations (n = 58). The results highlight the inherent ambiguity of the coordinators' working environment, the socially-disputed nature of their function and define the coordinators as connection-makers who exert power over processes rather than people or structures. It demonstrates that coordinators influence the policy process by inducing discussions at meetings and the documents subsequently produced. In conclusion, this paper defines coordinators as process managers whose work largely consists of translating policy plans through event connectivity and contextualizing practices. Given the importance of translation in policy implementation, this paper calls for a reconsideration of policy evaluation as well as of the coordinators' recruitment and training procedures.
AbstractThis article asks how policy learning is achieved and whether and how it impacts on policy change. By drawing on the empirical case of Belgian mental health reforms, it shows that policy learning occurs through the very practice of policy-making. In-depth analyses of the process of preparing and devising, a current reform of mental health care delivery, called Reform 107, evidence that the transformation of policy learning – through verbal expression, inscription in documents or enactment in social situations such as meetings – is crucial to its impact on policy change. A phenomenological approach to knowledge in policy helps to perceive and describe the transformation of policy learning through practical actions and interactions involved in devising policy change. Analytically, looking at this transformation entails shifting the focus from big and visible changes in policy objectives and instruments to micro policy practices such as meeting and writing documents. Placing the focus on micro policy practices should not lead, however, to a disregard for the social context in which they develop. The interactionist concept of linked ecologies provides the means to consider social regulations influencing policy learning without underestimating their very ephemeral and contingent nature.
Abstract This contribution focuses on a policy consultation process: the "transversal consultation". Launched in 2007 in the Belgian Mental Health Sector, this consultation had to capture the experience-based knowledge of service users and professionals involved in local projects aimed at experimenting working conditions in mental health care networks. This policy challenges the existing hospital-centred model of care, characterized by a medical approach and professional specialization, by promoting instead a pluridisciplinary approach in mental health care networks. In this contribution, a case of this transversal consultation process is analysed by relying on a theoretical framework drawn from the Sociology of Organizations and the Sociology of Public Action. The analysis emphasizes the strategic use that is made of the consultation process, and stresses the gap observed between its formal objective and its perceived outcome: more than producing experience-based knowledge about mental health care networks, the transversal consultation challenged power relations sustaining the current organization of the mental health system. It shortly discusses, as a conclusion, the outcome of the initiative.
This contribution focuses on a policy consultation process: the ''transversal consultation''. Launched in 2007 in the Belgian Mental Health Sector, this consultation had to capture the experience-based knowledge of service users and professionals involved in local projects aimed at experimenting working conditions in mental health care networks. This policy challenges the existing hospital-centred model of care, characterized by a medical approach and professional specialization, by promoting instead a pluridisciplinary approach in mental health care networks. In this contribution, a case of this transversal consultation process is analysed by relying on a theoretical framework drawn from the Sociology of Organizations and the Sociology of Public Action. The analysis emphasizes the strategic use that ismade of the consultation process, and stresses the gap observed between its formal objective and its perceived outcome: more than producing experience-based knowledge about mental health care networks, the transversal consultation challenged power relations sustaining the current organization of the mental health system. It shortly discusses, as a conclusion, the outcome of the initiative. ; Peer reviewed
