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Journal Articles Information Psychiatrique Year : 2020

[Psychiatry: Economic perspective and/or treatment options?]

[Perspectiva económica y-u orientación terapéutica en psiquiatría?]

Perspective économique et/ou orientation thérapeutique en psychiatrie?

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Abstract

In this paper, we aim to define the links that can exist between the current economic paradigm in the field of health and the treatment options promoted in psychiatry. To do this, we study the origins of health economics, particularly those in psychiatry, before moving on to analyze the French and English literature on the rehabilitation tools currently promoted by mental health policies in order to identify its objectives. It appears that health economics has its roots in strategic research conducted during the ColdWar by the United States and supported by industry players. Public policies have encouraged treatment on the basis of cost-effectiveness in order to reduce expenditure. For twenty years, mental illness has been considered a cost to society. Some indicators of the effectiveness of the approaches promoted using this logic connect economic efficiency and recovery. We identify the effects that this has had in the field of care, taking into account how the economic paradigm has guided treatment practices. What drivers are at work, and how in this context is it possible to maintain a clinical practice that takes into account the uniqueness of each patient? We finish by discussing the managerial logic that guides hospital directors, as well as looking at the ethical capacity of the practitioner to adapt the models to the needs of each subject, outside of a normativizing objective. Copyright © 2020 John Libbey Eurotext.
Relatamos con brevedad la aparición del paradigma económico en el ámbito de la salud y particularmente en psiquiatría para aclarar sus móviles. Desde hace unos 20 años, la enfermedad psiquiátrica y luego el mismo paciente son tomados como un coste para la sociedad. Algunos enfoques promovidos por las instancias de gestión modernas –por ejemplo, la readaptación psiquiátrica– se ven plebiscitadas por los administradores, pues arguyen su eficacia precisamente a partir del paradigma coste-eficacia que nos aparece que debe ser distinguido de la preocupación terapéutica. Concluimos, con el apoyo de las entrevistas, con la lógica de gestión que orienta las direcciones de establecimiento, y con la capacidad ética del médico para adaptar los modelos a las necesidades del sujeto fuera de un objetivo que normativiza.
Nous retraçons brièvement l'apparition du paradigme économique dans le domaine de la santé et particulièrement en psychiatrie pour en éclairer les ressorts. Depuis une vingtaine d'année, la maladie psychiatrique, puis le malade luimême, sont abordés comme coût pour la société. Certaines approches promues par les instances gestionnaires modernes - par exemple la réadaptation psychiatrique - sont plébiscitées par les administrateurs, car elles argumentent leur efficacité précisément à partir du paradigme coût-efficacité qui nous apparaît devoir être distingué du souci thérapeutique. Nous concluons, entretiens à l'appui, sur la logique gestionnaire qui oriente les directions d'établissement, et sur la capacité éthique du praticien à adapter les modèles aux besoins du sujet hors d'un objectif normativant. Copyright © 2020 John Libbey Eurotext.
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Dates and versions

hal-03702150 , version 1 (22-06-2022)

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Mickaël Peoc'H, Quentin Dumoulin, Pierre Bonny, Angeline Delalande, Yohan Trichet. [Psychiatry: Economic perspective and/or treatment options?]. Information Psychiatrique, 2020, 96 (4), pp.261-268. ⟨10.1684/ipe.2020.2094⟩. ⟨hal-03702150⟩
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