Canada's mental health最新文献

The challenge of cross-cultural health care is to work successfully with persons and communities whose cultural beliefs and assumptions regarding health, illness, healing, and human relations may differ in fundamental ways from those of the health care worker. Cross-cultural health care will be facilitated by acceptance of the concept of multiculturalism as a positive value for Canadian society by willingness to seek creative compromises between scientific and traditional cultural concepts of health and illness; and by health workers' comfort with the advocacy role, and their enjoyment of the challenge of learning about and working with people of diverse cultures.

The process of planning and implementing a computer information system in a suicide attempt counselling service is described. The discussion highlights the importance of: involving line workers at all stages, clearly defining the uses the data will be put to, and establishing a forum for periodic reviews of the system. The hardware and software options we elected to choose are also described.

This article, written following a survey of staff in a psychiatric hospital, analyzes how the trend toward deinstitutionalization has influenced institutional practice. Interviews reveal that intervenors support the objective of social reintegration, even if they find it a source of contradictions. In their daily activities, the staff are concerned mainly with improving their patients' quality of life, but this concern is also accompanied by the apprehension of encouraging dependency on the institution. Thus intervenors experience difficulty in focusing their practice on a system of representation capable of reconciling the ideal of rehabilitation with the characteristics of their clientele. Recognizing the paradoxes associated with work in the institutional setting does, however, make it possible to start a process of clarification that is likely to support intervenors and improve the quality of their relationship with chronic psychiatric patients.

A brief history of the development of a three-level system of security within the Ontario psychiatric hospital system is followed by a presentation of data regarding the maximum- and medium-security units and the patients in those units in 1984. A large proportion of the beds were occupied by patients held on Warrants of the Lieutenant Governor (WLGs). A review of the number of persons held on WLGs both in the province as a whole and in the medium- and maximum-security units over the past several years suggest that there will be an increased demand on these units for beds for WLGs in the future. The characteristic of medium- and maximum-security units are discussed and programs and program needs, are summarized.

An important consideration in discussing psychiatric patients' rights is the involvement of such patients in research. In clinical psychiatric research, ethical decisions must be made about patients' ability to understand fully the nature and scope of the study. When family members, social networks, and other aspects of the patients' living situations are included in the study, the researcher must also consider the added risk of invasion of privacy. This paper discusses these ethical considerations through a review of the literature and a discussion of several research studies using descriptive or exploratory designs. Some suggestions for dealing with these ethical dilemmas are offered.

In Canada, as elsewhere, there has been a shift away from institutional care toward community care for chronic mental patients. This transition has not occurred without some difficulties arising. In this paper, various major issues pertaining to the care of chronic mental patients in the Canadian health care system are discussed, including problems associated with deinstitutionalization; the defining characteristics and epidemiology of chronic mental illness in Canada; and the debate over the optimal setting in which to provide housing and treatment for chronic mental patients.

This paper discusses key issues with regard to planning interagency coordination of services for the mentally disabled. Basic questions which planners should address are: What is coordination? What functions are to be coordinated? What are the costs and benefits? What is the target population of clients and services? What type of structure is required and how should it be implemented? A continuum is constructed, along which various coordination structures are placed according to the degree of control exerted upon participating organizations. Requirements for successful coordination include skilled staff with positive attitudes; carefully developed procedures; good information systems; adequate funding; and facilitative policy that provides a clear mandate and direction.

The author offers a few reflections on the theme of the recent symposium of the Quebec Hospital Association: "De l'espoir à la Réalité" ("From Hope to Reality"). Twenty-five years after the report on quebec's psychiatric hospitals, what has become of the hopes and concerns of that time? Through all the changes that have occurred--from the hopes inherited from 1960 to the hopes articulated in the 1980s; from the "outmoded" realities of the institutional model to the realities considered "the way of the future", based on an ecological or bio-psycho-culturo-social model; from the preoccupations of the asylum to those of "mental health"--a fundamental question remains: Is the patient any better off? One might add a second question: WHich 'patient' are we referring to?

Resistance by clinical staff is a problem frequently encountered in the course of implementing an evaluation. This paper examines the process of developing a comprehensive evaluation for a case management program for the long-term mentally ill in Metropolitan Toronto. A participatory approach was used in the design and implementation of this evaluation. Parties involved included Ministry of Health officials, hospital administrators, outside consultants, the case manager co-ordinator, case managers, and the evaluators. The goal was to elicit both understanding and support from these key actors. The advantages of this approach are highlighted, as are the limitations and problems encountered.