Introduction
This chapter analyses the production of knowledge in mental health care networks during a policy process that took place in Belgium between 2007 and 2010. This process intended to test ‘The model of mental health care circuits and networks’ (NACH, 1997, 2007) developed by the National Advisory Council for Hospital Services (NACH), with the aim of reforming a mental health system that still depended on a model of hospital care. The development opened with an initiative called ‘Therapeutic Projects and Horizontal Consultation’, which comprised a set of pilot projects designed to test new forms of local service delivery in mental health care and to inscribe the resulting knowledge in documentary forms. These pilots were both local, designed to develop ‘therapeutic consultation’, and horizontal, designed to articulate the outcomes of local pilots in cross-project discussions.
By drawing on a case study of the horizontal pilot ‘Adults: General Psychiatry’ (AGP) – the discussion of different local pilots in adult general psychiatry – this chapter sets out to investigate empirically: how practitioners embodied knowledge of the new practices; how they came to enact that knowledge in the course of cross-project discussions; and how they coped with its inscription in a proposal for structural reform. At the same time, by also drawing on Actor-Network Theory (ANT) and the sociology of translation (Callon, 1999; Latour, 2007; Freeman, 2009), the discussion shows how ANT and the phenomenology of embodied, inscribed and enacted knowledge complement each another.
This chapter is composed of four main parts. The first briefly explains the background to the initiative; the second describes its design, emphasising that it is a very complex policy instrument, involving a number of different kinds of actors and different kinds of knowledge. The third part focuses on the case study of the AGP pilot. It starts from an assumption that the way a policy initiative is implemented impacts upon its meaning, as the meaning of inscribed knowledge is likely to change while being enacted. Rather than adopting a ‘static and compartmentalised’ model of knowledge, we therefore consider knowing as ‘something that people do’ (Blackler, 1995, pp 1021–3). In keeping with this approach to seeing knowledge in process, our case study relates the translation of the experience of mental health practitioners into knowledge inscribed in proposals for the structural reform of mental health services more generally.