Translating WHO’s recommendations into policies: a looping process of normative framing

This presentation proposal rests on empirical data collected through a European program named « Know and Pol ». The aim of our paper is to understand the process through which the recommendations emitted by the World Health Organization are translated in on-the-ground policy and practices in the Belgian mental health sector.

As for many countries, these recommendations and the care model they promote contrast on several points with the practices and the structure of the Belgian mental health sector. One element advocated by the WHO has in particular raised controversies and oppositions: the necessity to replace the traditional hospital-centered model by community cares within small ambulatory structures. Therein lies the principal criticism addressed to the Belgian mental health cares policy.

Through a focus on the reception of these recommendations and on a particular policy – “the therapeutic projects in mental health”, which can be seen as the last tentative to reform the organization of the sector –, we will analyze a process through which “big ideas” are translated in concrete policies.

Indeed, in spite of the lack of legal constraint, these recommendations have proved to have some kind of normative capacity. Nowadays in Belgium, every text or policy discourse (held by politicians, civil servants or representatives of the field actors) concerning the mental health policy acknowledges the WHO’s recommendations and this, despite the fact that they could be seen as antagonist to some actors’ interests. In order to understand this evolution, we shall refer to the Michel Callon’s concept of “point of obligatory passage” which underlines the creative activity of the actors who do not just receive passively these norms but, on the contrary, who reinterpret and translate these ideas in new policy. Our presentation will underline (1) that in spite of the antagonism between those ideas and some actors’ constituted interests, notably the representatives of the hospital organizations, these actors may reinterpret WHO norms strategically so as to fit with their own interests and the organizational context they are involved in. (2) We assume that such an interpretive work is possible because these recommendations do not provide a clear way to act but, can be used in order to imagine “new possible worlds”. (3) By doing so, these actors are legitimizing WHO’s recommendations and are reinforcing the possibility for other actors to use them in order to elaborate and legitimize new policies.

In conclusion, we’ll see that the process of reform and the influence of these norms are far from being direct and linear but, on the contrary, are long, iterative and constituted of “reinforcing loops”. At the methodological level, we’ll discuss the possibility to observe the multi-level process of elaboration of a policy through the materials (texts, declarations, evaluations…) produced and mobilized by the different actors. Indeed, with the interviews and observations, these materials constitute one of the major parts of our data collection.