In France, the ‘medico-social’ sector is a cross-sectoral field of support for persons with disabilities. Within this sector, mental health support services are expected to address a wide range of needs, promote independence, and foster the social inclusion and participation of persons living with psychiatric disabilities. Given these missions and ambitions, the article examines the similarities and differences between this framework and the public mental health approach, and draws lessons for implementing this approach in France.

Drawing on fieldwork conducted within two support teams located in a French metropolitan area—a Medico-Social Support Service (SAVS) and a Medico-Social Support Service for Adults with Disabilities (SAMSAH)—this study describes and analyzes medico-social support work through the lens of the ‘public mental health’ approach.

The article shows that these services promote prevention, care, and health education initiatives and that they integrate various determinants of mental health (individual, familial, social, environmental) into their understanding of psychiatric disabilities. However, because of their close integration into users’ daily lives of users, these support practices can also lead to forms of control over the choices, lifestyles, and living arrangements of those individuals. Furthermore, this work faces significant challenges, such as the complex coordination of cross-sectoral actions and tensions regarding the assessment of users’ degrees of autonomy or dependency. It can therefore be argued that medico-social support is partly aligned with the public mental health approach, but that it still faces political, organizational, and social obstacles to fully implementing this model.

Although these services adopt an approach akin to that of public mental health, their place within the policy and organizational landscape of psychiatry and mental health remains marginal due to their primary affiliation with disability policy. Indeed, these teams encounter difficulties in gaining recognition from mental health stakeholders and, consequently, in carrying out their work effectively. These difficulties also stem from the broad scope of their interventions and the specific cross-sectorial challenges they face. Furthermore, the scope of their missions and their embeddedness in user’ daily lives raise questions about their potential for social control.