Sante Mentale au Quebec最新文献

In Quebec, nearly 3 persons still take their own lives every day, even though this number has been declining since 2000. Several institutional and community actors are involved in suicide prevention and several initiatives have contributed to the reduction of suicide rates. Despite this hard work, additional efforts are needed to intensify service offers and resource access to better reach people at risk of suicide not reached by actual services. For many years, several countries have been implementing digital technologies to reach them. In Quebec, there were delays in adoption of digital technologies for suicide prevention. In this context, the Health and Social services Ministry mandated Association québécoise de prévention du suicide (AQPS) to develop a Digital Strategy for Suicide Prevention (DSPS). From the beginning, AQPS wanted to anchor DSPS's development in a decision-making process based on scientific, contextual and experiential evidence. A process, derived from implementation science, was therefore put in place to actualize this intent. Implementation science is defined as the science of implementing programs in real-world settings. It is recognized as contributing to the successful implementation of new programs while promoting a rigorous evaluation of their impacts and outcomes. Objectives This article aims to: 1) present the process that was put in place to facilitate DSPS design, implementation, and evaluation; and 2) describe the DSPS action model and the DSPS. Method The Knowledge to Action (KTA) framework is central to the design, implementation, and evaluation of DSPS. This framework proposes a cyclical process in 7 iterative phases, each with its own methodological aspects and data collections Results The results section illustrates the concrete actions taken at each phase of the KTA process and the highlights that emerge from the analysis of the data collected. This section also presents the DSPS. Conclusion Optimal conditions to promote the implementation of DSPS, its use and its sustainability have been put in place. The current implementation and evaluation of this implementation and its impacts will allow to assess the capacity of DSPS to achieve its main objectives: to provide information about suicide, to identify suicidal individuals, to increase the visibility of resources, and to offer help to suicidal individuals who respond less to traditional resources.

Objectives Exposure to repeated traumatic events during childhood and adolescence is associated with high prevalences of mental illness, addictions, physical health conditions, and psychosocial difficulties (Felitti et al., 2019). The most common consequence of exposure to trauma is violence towards self and others (Hughes et al., 2017). The very high prevalence of complex trauma among forensic mental health service users challenges these settings to modify their practices, training approaches, policies, and service delivery approaches. The objective of this article is to contribute to such a transformation of forensic mental health services by clarifying the impacts of complex trauma on the trajectories and experiences of forensic mental health services users, as well as practices responding to complex trauma. Methods We reviewed the published and grey literature on complex trauma among forensic mental health service users. After synthesizing the findings, they were contrasted with our experiences as clinicians and researchers in the field of forensic mental health care through the development of a case vignette. Results We first identify the role of complex trauma and victimization in the development and maintenance of violent behaviours. We describe the negative experiences of services and care settings reported by individuals with complex trauma in the absence of recognition and understanding of traumatic experiences and their impacts. We highlight the fundamental principles of trauma-informed care (trust and transparency; safety; peer support; collaboration and reciprocity; empowerment and choice; sensitivity to gender, cultural and historical differences), as well as the clinical and organizational approaches emerging from those principles. Next, we describe the approaches developed internationally to apply and implement trauma-informed care in forensic mental health setting, and the opportunities and challenges associated with their implementation in the Québec context. Conclusion To date, few studies have documented and evaluated the implementation of trauma-informed care in forensic mental health settings. The literature reviewed in this paper indicates that an in-depth understanding of complex trauma among forensic mental health service users should be at the core of contemporary forensic research, policies and practices.

Objectives The right to refuse care for accused persons found criminally not responsible on account of mental disorder or unfit to stand trial is recognized and strictly regulated by the legal mechanisms of Quebec civil law, and Canadian criminal law does not allow them to be treated against their will. Review Boards, which are responsible for ruling on and periodically re-evaluating their situation, cannot prescribe treatment, but have the authority, with the consent of the accused, to impose a condition relating to treatment. The purpose of this ethnographic study is to document the discourse and practices of the Quebec Review Board in this area. Method The research material consists of observations from the hearings of the Quebec Review Board (n = 70), file observation grids completed by defense lawyers (n = 191), interviews with psychiatrists (n = 7) and defense lawyers (n = 7) and the study of one hundred court decisions from 2018, randomly selected. Results Our study shows that the practices of the Quebec Review Board make it possible, directly or indirectly, through the ambiguity of conditions or the pressure exerted by certain treatment teams, to override the accused's refusal of care and to impose treatment. The implications of these findings for the evolution of knowledge and practices in forensic psychiatry are discussed. Conclusion While the Review Boards are supposed to manage the risk to public safety, they are in fact, in the context of the State's disengagement in social matters, exercising surveillance and control, in particular via the conditions relating to treatment.

Objectives The purpose of this study was to examine the unidimensional structure and psychometric qualities of the short version of the Kessler Psychological Distress Scale (K6) in adolescents living in Quebec. Method Data analyzed were obtained from the 2013-2014 Canadian Community Health Survey and included data from 1618 adolescents. The internal structure of the K6 and invariance by gender and age were tested using confirmatory factor analyses. Convergent and divergent validity of the K6 were also assessed. Finally, Receiver Operating Characteristic (ROC) analyses were performed to determine the predictive power of the K6 in predicting the presence of a major depressive episode. Results The analyses suggest the presence of a unidimensional structure in the Quebec adolescent sample, as well as in the studied subgroups. The invariance of the measure is observed for the age subgroups but cannot be established with certainty for the gender analyses. The results support the convergent and divergent validity of the K6 with adolescents, whereas the alpha and omega values of the K6 indicate that its internal consistency ranges from questionable to acceptable for all respondents and subgroups. The results of the ROC curves reveal that the 4/5 cut-off point best predicts the presence of a major depressive episode among all participants and subgroups. Conclusion Although the K6 has several advantages, the internal consistency and invariance by gender results warrant caution regarding its use to identify the level of psychological distress of Quebec adolescents.