L’objectif de cette étude était de donner des pistes de compréhension à la souffrance au travail des professionnels du secteur associatif médico-social. Nous avons donc mené une enquête qualitative sur les dossiers de patients issus de ce secteur vus à la consultation de psychopathologie professionnelle du centre hospitalier universitaire de Brest entre novembre 2013 et juillet 2015. Les références théoriques utilisées sont celles de la clinique médicale du travail et de la clinique de l’activité. En sus d’un contexte général, les cinq situations cliniques détaillées dans cet article amènent des pistes d’explication propres à ce secteur de cette problématique par des atteintes aux dimensions transpersonnelle et impersonnelle du métier, les dilemmes que posent la question des valeurs de l’association et l’isomorphisme coercitif.

Several surveys conducted about patients consulting for work-related mental disorders in occupational diseases centres have shown an overrepresentation of patients working in third sector organisations, especially in the social care sector (retirement homes, work reintegration facilities for the disabled). Our aim was to improve the understanding of the causes of work-related mental disorders among professionals working for third sector organisations in the social care sector. We performed a retrospective qualitative study, which was based on the analysis of the reports concerning patients having consulted the same physician between November 2013 and July 2015. Consultations were performed according to the clinical occupational medicine and the activity clinic theories. Patients’ files were anonymized when discussed by the occupational physician from the occupational disease centre, an ergonomist when a PhD in work psychology, and professor senior lecturer in sociology of work. Patients working in third sector social care organisations and suffering from work-related mental disorders were included in this study. Among the 102 patients having consulted during this period, 6 worked for social care NGOs. Among these patients, one patient was affected by a psychiatric disorder bearing no relation with his occupation and was therefore excluded from the study. Among the 5 remaining patients, two were nurses working in homes for disabled adults, two worked for work reintegration facilities for the disabled (one as a case worker and one as a director) and one worked as a secretary in a retirement house. They were affected by severe depressive disorders or adjustment disorders. One of the results of this study is that third sector social care organisations may affect the transpersonal dimension – i.e. the professional genre – which is linked to the pool of resources shared by groups of workers. A contradiction may also arise between tight budget constraints and the values which are invoked within a social care organisation, which in turn places workers in difficult situations. The impersonal dimension; namely the occupational framework and the working prescriptions may also lack of clarity. However, some of the causes of work-related disorders are not related to the legal status of the organisation, but rather to a lack of discussion in the workplace.