I believe it was Oscar Wilde who said that critics, like eunuchs, talk about what they do not do. I have kept away from the public sector of mental health services for many years now, but perhaps that is precisely why I am called upon with a certain regularity to set out my opinions there. Drawing on the memory of my own experience and on the — probably inadequate — observation of a few departments whose members sometimes ask me for supervision, it occurred to me that I might offer two or three pieces of advice to the candidate for the post of head of a psychopathology department or of a mental health centre.

In my view, they are close enough to what usually happens for them to be dismissed out of hand. In short, I hope they will be of a usefulness comparable to that of Carlos Sluzki’s excellent manual, published in the previous issue of Perspectivas Sistémicas under the title In three easy lessons: how to stake territory in the field of family therapy. Here they are.

Three pieces of advice to begin with

1) Find yourself a place where the department does not exist, or where it has so far remained obscure enough that you will not have to compete with past glories.

2) Whatever their number, take it immediately as given that the salaried posts are insufficient for the work to be done. This will be all the easier if you conceive of the said work out of everything that goes through your head and strikes you as interesting, without setting any programme, any tangible objectives, or asking yourself about criteria of priority. Never ask yourself what to do with what you have; look at everything that cannot be done for want of resources.

The salaried professionals must share this idea with you. It will help them to dilute responsibility; a well-measured feeling that resources are insufficient means that every omission and every mistake is forgiven and that every action takes on heroic shades.

3) On the basis of the above, authorise or encourage the entry of three hundred and twenty-five ad honorem professionals. You are now in a position to aspire to become important (which, that said, is not yet enough).

With a human group of this size, you will already have obtained a few results. a) Since the majority is not paid, it comes very little; and the salaried minority, which feels badly paid, shares in the general climate, so that it comes barely more.

The result will be that each professional actually sees half a patient a week, while taking part (provided he is not absent, since after all nothing can be demanded of him) in five weekly meetings, two of which will serve to discuss the lack of salaried posts and the others to plan a task that will not be carried out, for want of the man-hours to do it. b) With such a workforce, consulting rooms will be lacking in the morning and will stay empty in the afternoon, which will in turn allow you to demand either more consulting rooms or more salaried posts.

Good: now that you have a department with a great many people in it, set about improving it. There are several ways of doing so, but they can basically be grouped into two categories: teaching and care.

Teaching, or the art of being in touch with the prophets

a) Teaching: get hold of plenty of supervisions delivered by well-known people. It is important that your staff should feel they are in touch with the prophets. Then, in practice, very few people will attend the courses and supervisions given by the very person to whom succulent fees are paid in private. The prophet himself will be absent a good number of times, since after all he too feels a heroic victim contributing to a mean-spirited State that fails to acknowledge his sacrifice. The practical result is that everybody will know that at that time of day nothing else can be done, since there is teaching, and will as a rule enjoy this important activity in imagination.

In case your people lack imagination and prefer the real exercise of the activity to dreaming about it, see to it that both your teachers and the bibliography in use place particular emphasis on a language that makes it possible not to understand what therapists do to make treatments fail. If attention bears on what is called theory, or if a technical procedure is raised to the rank of sacred rite, therapists will be able to work there quietly for years without knowing whether their effectiveness is equal to, greater than or less than average and, better still, without even being interested in knowing. It does not take much: as a rule, an intensive use of key words such as resistance, incapacity for symbolisation or operative thinking, autopoiesis or structural drift, is all one needs.

The other point you ought to keep an eye on — but without too much effort, since the staff and the supervisors will see to it with spontaneous goodwill — is that nobody should seriously raise the question of the technical and operational differences between public institutional work and private individual practice. If your department is truly at the cutting edge, it will have to be said that these differences exist, but never spelled out, for one runs the risk of discovering that what is learned in one context is of no use whatever in the other, since they are very different operations. As long as these differences remain unclear, any number of therapists will be able to tinker away with their hospital patients, trying out on them the approaches they hope to use with their private clientele, statistically ever thinner.

Care: broad, complex and interdisciplinary

b) As regards care, see to it that your department is broad and complex.

Add another characteristic to it: it must be interdisciplinary, which as a rule means that the doctor, male or female, and/or the psychologist, male or female, consider that it is up to the social worker to do the dirty work of going to people’s homes to confirm their own theory about the case. Since she usually comes back with a different theory, the people who come for consultation quickly become the pivot of the struggle to determine the supposedly most appropriate approach.

Write nothing, know nothing, and the sublime paradox

Since nobody is under any obligation to put in writing what he does, all the professionals can choose between carrying on doing what they do without learning anything of what the others do, or learning it and getting angry about it without consequence: since they all work at different hours, it is very difficult for them to meet. Questions of the kind “on the basis of what criteria was this case referred in this way, and accepted out of hand?” must be brushed aside.

Any analysis of the impact that the functioning of one’s own organisation has on the maintenance or the worsening of symptoms must be carefully set aside or, at worst, referred back to the question of the lack of resources. By this device, many families get better: from feeling pawed about and misunderstood, a healthy reaction is produced in them which leads them to place more trust in their own resources.

In the meantime, you will already have a numerous, broad, complex and interdisciplinary department. You can improve it still further by adding hospital liaison or primary prevention services, but I shall come back to that another time, for those are genuine refinements.

In any case, you can already sit down to savour the fruit of your efforts and meditate on a marvellous and sublime paradox: with only fifteen salaried therapists and three hundred and thirty-five ad honorem ones, every service provided costs the State what it would cost if it paid for it at private-practice rates.