ED Sociétés, Politique, Santé Publique
Recovery within mental health practice: instruments and levers for change
by Simon FELIX (Laboratoire de Psychologie)
The defense will take place at 14h30 - Amphitéâtre Pitres 3 ter Place de la Victoire, 33000 Bordeaux, France
in front of the jury composed of
- Antoinette PROUTEAU - Professeure des universités - Université de Bordeaux - Directeur de these
- Christophe LANCON - Professeur des universités - praticien hospitalier - APHM Hopitaux Universitaires de Marseille / Aix-Marseille Université - Rapporteur
- Stéphane RAFFARD - Professeur des universités - Université Paul-Valéry Montpellier 3 - Rapporteur
- Marc CORBIERE - Full professor - Université du Québec à Montréal (UQAM) / Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR-IUSMM) - Examinateur
- Deborah SEBBANE - Docteure - Centre collaborateur de l'OMS pour la recherche et la formation en santé mentale (CCOMS) - Examinateur
(Provisoire - modifications prévues fin août avant dépôt final manuscrit) According to the World Health Organization (WHO), in 2019, one in eight people worldwide was living with a mental disorder. Severe mental illnesses (SMI) are associated with significant restrictions in societal participation, often resulting in substantial disability. Yet, recovery from SMI is not only possible but also frequently observed (Harding et al., 1987; Harrison et al., 2001; Harrow et al., 2005; Slade & Longden, 2015; Warner, 2010). In contrast to the biomedical model of mental illness, international user-led movements define recovery as a subjective, personal, and individual process through which people “build a meaningful and fulfilling life, and a positive sense of identity founded on hope and self-determination” (Andresen et al., 2003). This definition, commonly referred to as “personal recovery,” deliberately departs from symptom remission or functional recovery objective criteria, typical of the biomedical approach. The adoption of this approach by mental health professionals has marked a major paradigm shift in the care of individuals with SMI (Davidson, 2005; Slade et al., 2014). In line with WHO recommendations (2021), many countries are reforming their mental health systems to prioritize supporting people with SMI in their recovery journeys (Subandi et al., 2023). This commitment, described in the literature as a “recovery orientation,” entails profound transformations in the organization of mental health services as well as in professional practices, overall aiming to better support personal recovery. France is also part of this global movement to transform mental health practices. The development of territorial mental health projects (Decree No. 2017-1200 of July 27, 2017) reflects a national commitment to adopting a recovery-oriented approach to psychiatric care. This doctoral work, conducted within the RECOR research program, is situated within this context and aims to produce scientific knowledge that supports the transformation toward recovery-oriented mental health services and professional practices. It addresses three main areas of research. The first area focuses on personal recovery outcomes, which are essential for integrating this concept into both care practices and service evaluation. A systematic review of the literature was conducted to identify reliable and valid outcome measures of personal recovery, and one of these tools was subsequently adapted and validated in French. The second area concerns the integration of service users' perspectives in the assessment of care quality. To reflect the priorities of those most directly affected, this evaluation must incorporate the concept of personal recovery. A measurement scale was adapted and validated in the French context, enabling users to assess the recovery orientation of mental health services, that is, the extent to which the service's functioning and professional practices align with the principles of the recovery approach. Finally, the third area of research focuses more directly on mental health professionals. A comprehensive assessment was needed to identify their training needs and potential levers for supporting changes in practice. To this end, a national survey was conducted with the aim of examining professionals' beliefs, attitudes, and practices related to recovery, as well as exploring the factors that influence them.
Effectiveness of perennial malaria chemoprevention: Insights from an implementation research project in Southern Togo
by Shino ARIKAWA (Bordeaux Population Health Research Center)
The defense will take place at 14h00 - Salle Nightingale 146 rue Léo Saignat, 33076 Bordeaux
in front of the jury composed of
- Valérie BRIAND - Directrice de recherche - Inserm (UMR1219), Institut de recherche pour le développement (EMR 271), Université de Bordeaux - Directeur de these
- Didier EKOUEVI - Professeur - Inserm (UMR1219), Institut de recherche pour le développement (EMR 271), Université de Bordeaux - CoDirecteur de these
- Valériane LEROY - Directrice de recherche - UMR 1295, Inserm, Université Paul Sabatier Toulouse 3 - Examinateur
- Ghislain SOPOH - Professeur - Institut Régional de Santé Publique - Examinateur
- Renaud BECQUET - Directeur de recherche - Inserm (UMR 1219), Institut de recherche pour le développement (EMR 271), Université de Bordeaux - Examinateur
- Gilles COTTRELL - Directeur de recherche - Institut de recherche pour le développement - Rapporteur
- Bich-Trram HUYNH - Directrice de recherche - Institut Pasteur - Rapporteur
Malaria remains a major public health issue in sub-Saharan Africa, particularly among young children. Despite the WHO's 2010 recommendation, only Sierra Leone has adopted intermittent preventive treatment for infants (IPTi), which involves administering a full therapeutic course of antimalarial drugs (namely sulphadoxine-pyrimethamine, SP) during routine immunization visits. The WHO recently renamed IPTi as perennial malaria chemoprevention (PMC), recommending broader age eligibility and tailored strategies for country-specific needs. While this flexibility enhances country-driven approaches, effective PMC implementation requires more evidence. MULTIPLY is a 40-month PMC research project administering up to six doses of SP to children in selected districts of Mozambique, Sierra Leone, and Togo. The project offers a unique opportunity to address key implementation questions, including pre-existing EPI coverage (as PMC delivery relies on strong immunization services) and its influence on malaria incidence. Togo's data was analyzed in this PhD thesis. Baseline survey data in Togo's Haho district showed high malaria prevalence (32.1%) among children under two, with geographic variation. Risk factors included living in mother-headed households (aOR 2.39, 95% CI 1.43–3.99), residing over 5 km from a health facility (aOR 1.60, 95% CI 1.04–2.44), and households with multiple children under five (aOR 1.44, 95% CI 1.01–2.07). Immunization coverage was low - only 60.7% of children under two were fully vaccinated, while 15.8% remained zero-dose. Vaccine uptake declined with age, dropping from 84% at birth to 35% for the second measles dose at 15 months. Barriers included family discouragement (17.4%), and lack of time (15.1%). Zero-dose status was associated with caregiver lower education (aOR 5.02, 95% CI 1.85–13.60), vaccine safety concerns (aOR 8.60, 95% CI 3.32–22.30), and non-reliance on modern healthcare (aOR 3.06, 95% CI 1.26–7.48), while geographic access did not significantly impact immunization. Longitudinal data suggested PMC's effectiveness in reducing malaria incidence. The 24-month malaria incidence was 17.8 per 1,000 person-months in PMC-exposed children versus 35.8 per 1,000 in non-exposed children (incidence rate ratio: 2.01, 95% CI 1.43–2.87). This thesis highlights PMC's potential to significantly reduce malaria when integrated into existing immunization platforms. However, challenges like low EPI coverage and high zero-dose rates could limit its reach. These findings provide vital operational evidence for designing country-specific PMC strategies, as recommended by the WHO.