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The article presents a paper, a part of a planned series of Elements of Care papers, focusing on identifying common elements which are important for providing appropriate psychiatric care in different models of care in Canada. It focuses on direct patient care or service for payment in traditional care model and also discusses indirect services involved in such models, like diagnostic assessment or patient management. It also focuses on involvement of family or caregivers in indirect services.

The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system. [ABSTRACT FROM AUTHOR]

This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21 st century psychiatry. [ABSTRACT FROM AUTHOR]

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making. [ABSTRACT FROM AUTHOR]

Over the past quarter-century, Canadian researchers, clinical practitioners, and policy specialists have made several notable contributions to the broad field of violence risk assessment and management. In part, these contributions have been fostered by major changes in law over this period; in part, they have been spurred by findings from large-scale Canadian prediction--outcome studies. This paper offers references for a range of Canadian-inspired assessment schemes designed to evaluate psychopathy and potential for violence against others. [ABSTRACT FROM AUTHOR]

In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry. [ABSTRACT FROM AUTHOR]

Objective: Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment.Methods: We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment.Results: Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak.Conclusions: Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. Methods: We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. Results: Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. Conclusion: The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers. [ABSTRACT FROM AUTHOR]

Confusion regarding definitions and standards of prevention and promotion programs is pervasive, as revealed by a review of such programs in Canada. This paper examines how a discussion of scientific paradigms can help clarify models of prevention and mental health promotion and proposes the complementary development of prevention and promotion programs. A paradigm shift in science contributed to the emergence of the transactional model, advocating multiple causes and dynamic transactions between the individual and the environment. Consequently, the view of prevention applying over a linear continuum and of single stressful events causing mental disorders may no longer be appropriate. It is the author's belief that the new science of chaos theory, which addresses processes involved in the development of systems, can be applied to child development and thus to the heart of prevention and promotion programs. Critical moments followed by transitions or near-chaotic behaviours lead to stable states better adapted to the environment. Prevention programs would focus on the critical moments and target groups at risk to reduce risk factors. Promotion programs would focus on stable states and target the general population to develop age-appropriate life skills. The concept of sensitive dependence on initial conditions and certain empirical studies suggest that the programs would have the greatest impact at the beginning of life. It is hoped that this effort to organize knowledge about conceptual models of prevention and mental health promotion programs will foster the development of these programs to meet the urgent needs of Canadian children. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article requests for expert opinions. The journal will concentrate on its academic mandate, accepting only empirically based studies and systematic reviews. The editor is not really happy about turning down other types of papers, as well as no longer publishing case reports as letters. However, Its focus has to be on papers that contribute to the development of scientific psychiatry.

The article presents an overview of the research papers that were published in the August 2006 issue of the "Canadian Journal of Psychiatry." An insightful and accessible overview of the literature on the relation between cannabis use and psychosis is provided. Important cannabis-related harms that include the prevalence of cannabis dependence in the community is discussed.

The author reflects on the developments surrounding the August 1997 issue of the journal "The Canadian Journal of Psychiatry." In the leading paper, author Michael Ruiner familiarizes the reader with his latest preoccupation. He defines genetic research to include a thorough understanding of the multiple interplays between genetic structures and the outside world.

This article focuses on the new editor and new policy of the "Canadian Journal of Psychiatry." With the change of editorship. The journal will introduce several other changes. The journal's mission is to publish papers of the highest scientific quality that are relevant for the theory and practice of psychiatry. All the articles in the journal are either empirical studies or systematic reviews. As a result, our impact factor has steadily gone up. While Canada is small in relation to its larger neighbor country, one do not see why one cannot have an impact similar to that of journals from Britain and Scandinavia.