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Organizing mental health care: What is the right place for child psychiatry expert centers? Volume 99, issue 8, Octobre 2023

Authors
1 Service de Psychopathologie de l’enfant et de l’adolescent, Hospices civils de Lyon, Bron
2 CRMR Dev-Gen, Service de psychopathologie du développement, Hospices civils de Lyon
3 Institut d’histoire des représentations et des idées dans les modernités, ENS de Lyon
4 Centre de Recherche sur l’épidémiologie de la santé et des populations, Université de Paris-Saclay, Villejuif
5 Addipsy, Centre ambulatoire d’addictologie et de psychiatrie, Groupe santé Basque Développement, Lyon
6 Service de Médecine et de SSR, Centre hospitalier spécialisé le Vinatier, Bron
7 Pôle de Psychiatrie de l’enfant et de l’adolescent, Centre hospitalier spécialisé le Vinatier, Bron
8 Internat de psychiatrie, Université de Picardie Jules Verne, Amiens
9 CH de Saint-Cyr-au-Mont-d’Or, Saint-Cyr-au-Mont-d’Or
10 Laboratoire Research On Healthcare Performance (RESHAPE), Service d’économie de la santé, Hospices civils de Lyon, Université Claude-Bernard, Lyon
* Correspondance : P. Espi <pauline.espi@chu-lyon.fr>

Our care practices and child psychiatry systems are currently undergoing radical transformation. We are seeing more and more assessment, coordination, and research structures being set up, while CMPs (medico-psychological centers) and CMPPs (medico-psycho-pedagogical centers) are struggling to fulfill their care missions. In this article, we suggest some ways of analyzing these difficulties and raise the issues of legitimization and delegitimization of professionals that may arise from the growing power of expert centers (financially, organizationally, and in terms of the authority of their discourse). We discuss the promise of expert centers, but also their limitations and potential pitfalls, both in terms of clinical and diagnostic approaches, and in terms of positioning within the community. We propose the hypothesis that there are in fact two types of expert position in child psychiatry: the specialist who specializes in a particular type of disorder (the clinician at the expert center), and the specialist who specializes in that particular child (the child himself, parents, educators, main caregivers). We defend the idea that these two areas of expertise need to be recognized and connected, and that we need to think about the conditions under which such a connection is possible, in care organizations as well as in the relationships between actors in the therapeutic community, and in the ways in which knowledge is transmitted.