Practice variations in French public psychiatry and associated factors (PRAVA-PSY) Background As in other countries, mental disorders in France represent a significant epidemiologic and economic burden that is expected to increase dramatically. Practice variations across public psychiatric services are a source of inequity and inefficiency and thus challenge the quality of care. While the need for evidence-based policy has been emphasized, research on practice variations in French public psychiatry, which represents two-thirds of mental health care delivered to patients in terms of expenditure, does not exist. Objectives The objectives of our study are threefold: 1/ To produce evidence on practice variations in French adult public psychiatry; 2/ To have a better understanding of the factors associated with mental health care practice variations; a. To identify characteristics of the providers of public psychiatric care that are associated with practice variations b. To identify patient characteristics that are associated with practice variations c. To identify the characteristics of the environments of the providers that are associated with practice variations; 3/ To develop recommendations on how to develop and implement policies to reduce unwarranted practice variations and to direct future research. Methods First, we will use descriptive analysis to describe practice variations and assess their ranges across French adult public psychiatric organizational units (PPOUs) using data from the Summary of medical information for psychiatry (RIM-Psy). A set of variables will be used to describe practice (e.g. average length of stay, annual re-hospitalization rate, etc.). Second, we will investigate factors associated with practice variations for mental disorders by using multivariate modeling. Three steps will be successively undertaken: 1) Hypotheses on predictors of practice variations, including characteristics of providers (PPOUs), their patients and their environments, will be developed to construct an explanatory model for each variable describing practice. 2) Database on predictors will be prepared. 3) Models will be run. Third, on the basis of the results, conclusions will be drawn with experts through a workshop bringing together decision makers, mental health care professionals and patient representatives to issue recommendations to address unwarranted practice variations and thus improve equity and efficiency in the system. Skills in health research services, statistical analysis, workfield psychiatry and health geography are needed for the completion of this project, and a multidisciplinary team has therefore been built. Prospects This project will enable a better understanding of the factors associated with practice variations in French public psychiatric care. These findings will be published in peer-reviewed journals and will have implications for policy-makers as they will provide evidence to improve the organization of public psychiatric care in France. Recommendations will be issued and further work will be developed based on the results of the project.