Therapeutic projects in Belgium : a post-bureaucratic way

Since the end of the 1980s, a new vision of mental health has been developed
under the influence of the Belgian "Psychiatry" permanent work group of the National Council
of Hospital Facilities. This new vision adopts a holistic perspective which takes into account
the diversity of factors at stake and aims to give a central place to the patient and his or her
needs. The principles on which this innovative vision lies fall within an international trend
(among other developed in the WHO declaration of Helsinki) which aims to put the patient at
the centre of the system but also in field actor practices. This vision is made concrete in a
restructuring of mental health care sector in terms of care circuits and networks, which
necessitates an "interinstitutional" and interdisciplinary cooperation. With this approach the
old bureaucratic model of organising a sector would be replaced by a post-bureaucratic one
marked by notions such as networking or negotiation. The "Therapeutic projects", organised
by a Royal Decree in 2006 after a long term decision making process, constitute the
experimental phase of this new mental health care concept. It is a wide ranging pilot project
which aims to achieve, by the end of the three-year experimental phase, the definition of
guidelines and the implementation of norms as regards mental health care circuits and
networks. The purpose of this contribution is to (1) give a presentation of the mechanisms
which have lead to the creation and implementation of the therapeutic project. Using a case
study method, we will also (2) analyse the functioning of a therapeutic project, showing at
the one hand the tensions between the philosophy of the project (network functioning and
flexibility) and the technocratic temptation developed by the administration which funds
them, and, at the other hand, we will also examine how the "traditional" psychiatric
rationality is able to maintain its central position in a context where other fields and actors
should emerge. Finally, (3) as the data that we present have been collected during a FP6
integrated research project which aims to analyse the links between (new forms of)
knowledge and policy making, we will develop a methodological discussion about the way
sociology (of law) can trace the place and role of knowledge in policy making."