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The following dialogue was produced from interviews between a psychiatrist and a child psychiatrist, both working in a community setting in Lyon and the surrounding area, and two generalists based in Lyon. The conversation demonstrates that in the current context of strain on access to psychiatric care, relations between generalists and psychiatrists are characterized by recurring strategies. While generalists want to secure access to institutional care for their patients, psychiatrists want to control access to overwhelmed services. These strategies are based on institutional limitations and weaknesses, but also on a misuse of clinical care, used not to heal but to shut individuals out of services. We propose to identify forms of co-operation that provide a way to develop solutions adapted to the realities of patient care.