Canada's mental health最新文献

The Guest Editor for this special theme issue on "organizational dilemmas" discusses factors affecting the delivery of mental health services from the perspective of "psychopolitics," a concept that refers to the complex forces, relationships, and interactions within and around mental health service systems. The author outlines briefly the contents of the theme issue, and makes a plea for the development of effective strategies for shaping organizational structures to meet client needs. Education, communication, and the cultivation of cooperative rather than adversarial relationships will help to resolve organizational dilemmas.

During the last 20 years there has been considerable progress in the development of rehabilitation knowledge and philosophy, particularly in the behavioural and social aspects of programming. Frequently these changes are not applied, either because of lack of information amongst senior staff and board members, or because of pressures within the community. The article describes issues and concerns related to agency function, including changes that need to occur in philosophy and operation to provide a more individualized service.

Modern health care has placed increasing demands on health professionals to expand their roles or to create new roles in order to provide comprehensive service to clients. An understanding of various social theories is an essential background when planning and undergoing a process of transition from one role to another. The authors have applied principles from these theories to the process of role change or innovation in organizations. A problem-solving format is used to outline the process of entry to a clinical system and planning a role change. This practical guide formulates the questions to be addressed during the process and can be used by practitioners or by educators of any professional discipline.

The concept of normalization is an influential paradigm in mental health. However, little attention has been paid to how the psychiatrically disabled fare in the competition for generic services. Four psychiatric aftercare areas were examined: income maintenance, housing, vocational-educational, social-recreational. Results indicate that generic services do not successfully support the chronic patient in three of the four areas examined. Only in the field of vocational-educational support have generic agencies made a serious effort, and even here the most seriously disabled patients still rely on specialized services. The authors suggest that the theory of normalization is constructed on fundamentally erroneous assumptions and discuss alternative rather than normative programs for the long-term mentally ill.

The author discusses what he considers a fundamental change in the political, economic and social value system since the mid-1970s, and how this change is reflected in three trends of particular relevance to mental health services: the growing emphasis on the "residual" model of welfare; the "privatization" of mental health service delivery; and the tolerance of high levels of long-term unemployment. He criticizes the assumptions underlying these trends, and emphasizes that the choice of social and economic priorities is ultimately based on values rather than on empirical data. Accordingly, he argues for broad societal participation in the choice of priorities.

It is typical of the Provincial Divisions of the Canadian Mental Health Association to provide or oversee direct services for mentally disordered persons and for high-risk groups, and also to act socially and politically as advocates on their behalf. In Saskatchewan the relationship between the CMHA Division and the provincial government is described as one of "quiet negotiation and occasional publicly conducted conflict resolution". Some of the accomplishments of this effective working relationship are described.

The authors discuss legal issues which bear on the provision of mental health services for children; in particular, the dilemma of balancing the child's right to protection and autonomy with his/her right to competent, compassionate treatment. The role of the mental health professional in court and the role of the law in children's mental health facilities are examined. The authors suggest that the growing dialogue between lawyers and mental health professionals has already helped to clarify important legal and service issues.

Gross demographic data are supplied on all patients held under Warrants of the Lieutenant Governor in Canada. The composition of the total population varies considerably from one province to another, with resulting differences in such important factors as total time spent on warrant. A plea is made for some kind of continuing monitoring of this expensive-to-treat group, and it is argued that the Boards of Review are, because of lack of basic statistical information, at an unnecessary disadvantage when it comes to making decisions as to whether to release individuals or not. It is suggested that a fairly simple information and tracking system could reduce treatment costs, with concomitant decreases in confinement of patients, without at the same time increasing risk of harm to the general population.

The author summarizes current law and trends affecting the right of psychiatric patients to refuse or consent to treatment. The discussion addresses the key principles involved: autonomy and inviolability of the person. Relevant provincial mental health legislation in effect at the time of writing is briefly reviewed. Finally, the possible impact of the new Canadian Charter of Rights and Freedoms is discussed.

The author briefly discusses negative attitudes and prejudices held by some helping professionals, and the consequences for the patients in their care. She stresses the need for mental health workers to maintain respect for their clients from the outset, and to support them in their struggle for growth and self-esteem, rather than becoming detached from them, patronizing them, or blaming them for their illness. Respect requires humility in the face of another's misfortune, and a strong affirmation of our common humanity.