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1 results

  • 3 - Before Deinstitutionalization

  • Isabel M. Perera, Cornell University, New York
  • Book:
    The Welfare Workforce
    Published online:
    02 January 2025
    Print publication:
    16 January 2025, pp 55-78
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  • Summary

    To set the stage for the US–French case comparison, this chapter shows how the political economy of mental health care was similar in the two countries prior to the Second World War (the critical juncture that initiated deinstitutionalization). One difference, though, stands out: the possibility of coalition formation between workers and managers in public mental health services. On the labor side, French public sector trade unions acquired full legal rights after the war, but the maturation of their US counterparts was late, limited, and staggered across the states. On the management side, the organization of French public psychiatric managers was better equipped to enter into this coalition than its American counterpart. I discuss how these differences came to be. Special attention is paid to the economic interests that drove psychiatrists’ intra-professional conflicts and how their gradual settlement produced diverging organizational outcomes. A discussion of potential confounding factors closes.