My core research program asks why an international trend to “de-institutionalize” people with psychiatric conditions resulted in different levels of mental health care supply in different countries. Although some countries closed public mental asylums, others did just the opposite and instead expanded the supply of public (multipurpose) mental institutions. With the analytic tools of comparative political science and two new data sets, I select two cases at each extremity of the supply spectrum — the United States and France — and then trace them using archival and other historical primary sources.
The comparative study reveals the importance of an overlooked factor: the role of public sector trade unions. Where structural conditions allowed public psychiatric workers to gain the support of their managers, asylums did not close. Rather, this coalition with management advanced public policies that raised wages and protected employment, increasing the supply of public psychiatric services (and feeding resources into public employment). Where public managers and workers could not form a coalition, however, negative feedback ensued (i.e., public employment and services weakened).
This central finding leads to three main contributions:
- By examining the political conditions that shape the supply of social services, it brings an understudied actor, public sector labor, to contemporary debates about distributional politics. Contrary to expectations, services for vulnerable populations are not necessarily under-supplied. Although it is true that vulnerable clients lack the political and economic resources to demand services, those who depend on these services for their employment are likely to become their most vocal defenders.
- By theorizing when and how public workers succeed, the study inverts a standard assumption of management-labor antagonism in political economy. Unlike service workers in the private sector, service workers in the public sector are more likely to organize cooperatively with their managers – a political possibility unavailable in other forms of industrial relations.
- By applying the tools of comparative political science to an interdisciplinary research agenda, the study offers a systematic explanation for what have otherwise been treated as isolated, idiosyncratic national experiences of psychiatric deinstitutionalization.