Les dispositifs de délibération en santé mentale et la démocratisation des échanges entre les pairs : le cas de l’assemblée des usagers d’un centre d’attention psychosociale au Brésil Deliberative devices in mental health and democratization peer exchanges: the case of a user’s assembly of a psychosocial care center in Brazil

Résumé

Le réseau public de services de santé mentale de la ville de Campinas dans l’État de São Paulo au Brésil est constitué de divers dispositifs de délibération impliquant des personnes utilisatrices. L’assemblée des usagers dans les centres d’attention psychosociale (CAPS) constitue un exemple clé de ce genre d’innovation participative fondée sur des principes de démocratisation et de justice sociale. Est-ce que l’assemblée des usagers comme dispositif délibératif institué agit sur les inégalités sociales de pouvoir et le rétablissement des personnes ? Il s’agit ici de rendre compte de certains résultats d’une recherche qui a pour objectif de saisir si de tels dispositifs agissent sur la démocratisation des rapports sociaux du point de vue des personnes utilisatrices impliquées, et comment. À partir d’une ethnographie organisationnelle de près d’un an dans un CAPS du réseau public de santé mentale de Campinas, il a été constaté comment les échanges créés au sein et en dehors de l’assemblée des usagers participent à l’émergence d’une forme de pair-aidance spontanée et informelle. Ce constat permet de réfléchir sur le rapport entre cette pair-aidance implicite et la circulation des personnes dans une pluralité d’espaces collectifs ouverts dans lesquels celles-ci peuvent partager des affects et critiquer librement au sujet des services reçus.

Mots-clés :

• dispositifs de délibération,
• démocratisation,
• échanges transversaux,
• pair-aidance implicite,
• Brésil

Abstract

Several mental health public networks in Brazil focus on the participation of a plurality of actors in different collective methods of analysis and co-management of services in order to ensure improved efficiency and greater democratization of social relations. It is clear that the analysis of the effectiveness of these collectives is often done at the expense of the social relations of power they help produce. In other words, it is as if the participatory nature of the devices immediately ensure their democratic potential and their positive impact on the recovery of the users involved.

Research is presented that seeks to understand the point of view of the actors involved and to determine whether or not collective spaces for the organization of mental health services contribute to the democratization of social relations that is, the construction of individual and collective capacities for debate, decision and public action. What and how people living with serious mental disorders are protagonists in the design of service and in the struggle for quality public services and how this is involved in their recovery?

The research is drawn from an organizational ethnography carried out over nearly one year in Campinas, Brazil in 2012. The research focuses on a case study in a psychosocial care center (CAPS) housing for people living with serious mental disorders. To consolidate the internal validity of the case study, three collecting data techniques were applied: the shadowing over 17 institutionalize methods or devices involved in the organization of services of the CAPS, analysis of documents and forty-seven personal interviews with users, managers and workers. This article focuses on the data from the observation of one of these devices deliberation involving users, the user’s assembly, as well as interviews with 15 of these participants.

The results highlight how peer exchanges, emerging in the assembly of users and the convivencia space lead to collective mobilization to improve services, social and political involvement, mutual help and to complicity and friendship. These exchanges contribute in fact to the emergence of informal peers support based on affect and critical debate. It is not the assembly of the users, but the circulation of peers, at different times of their institutional courses, in various open spaces that trigger the emergence of exchange slowly building the ongoing process of democratization. In conclusion, such observations expose the importance of creating free open space where peers at different times in their recovery process can circulate and talk together. This circulation tends to encourage informal pair support, friendship and political involvement from the time it is deployed in a plurality of open common areas; that is to say, areas where there is room for spontaneity and for the expression of affects among peers.

Keywords:

• deliberative devices,
• democratization,
• transversal exchanges,
• implicit peer support,
• Brazil