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Nurses will soon be able to develop advanced practice in mental health through a state certified diploma. This new role will see caregivers acquire other competencies, such as prescribing, and marks a development of the profession through the growth of nursing sciences. The evolution of practices and the clinical approach in care would gain from collaboration between advanced practice nurses undergoing training and qualified clinical nurse specialists. Based on feedback from nurses in the field, perspectives for collaboration and organisation are assessed in terms of the health challenges facing our society., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

In France more than 140 000 children live in foster homes under the responsibility of the French Child Protection Agency. These children have lived in environments that cannot be good for their development and have been separated from their families which have to have consequences on their mental development. A literature review in France and abroad was made to identify the profiles of these children, their risk factors, and the mental disorders they can present. French child protection is handled by smaller territories, called Départements of which there are more than 90 and count around 1 000 000 people each. The number of foster children differ byDépartement, as do the placement types and meaning of the placement. More than half of these children have suffered maltreatment prior to placement. Comparing them to children of the same age, they present more internalizing and externalizing disorders, more addiction problems and suicidal behaviors. Protection factors have nonetheless been identified, such as early age of placement and placement stability. The main inhibitors of good health care are the absence of a common regulatory framework, source of organization difficulties, and the lack of collaboration between health and social services. French cohort studies using validated tools are necessary to precise and confirm these results. They could then lead to national recommendations for mental health screening and care organization, as well as validation of protocols for specific therapies for foster children., (Copyright © 2019 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Delphine Chipponi has been working for 15 years in psychiatry and focuses on training as a way of enriching the global approach to care., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

In recent decades, two processes have been crucial for the development of psychotherapy regulation, which are interlinked and mutually reinforcing: efforts to legalise psychotherapy as an autonomous profession, and efforts to academise psychotherapy as an autonomous scientific discipline. While in Europe the European Association for Psychotherapy (EAP) plays a key role in efforts to legalise psychotherapy as an autonomous profession, the academisation of psychotherapy in the twentieth century started at postgraduate level, then, after the Bologna reform, at Masters and Doctoral level and, since 2005 also at undergraduate level, first in Austria and then in Slovenia and Germany. Based on brief descriptions of the regulation of psychotherapy in some European countries – Germany, Sweden, Finland, Austria, Malta and Croatia – it is pointed out that concern for equitable access to psychotherapy and its quality for those in need of such kind of help must be a key criterion and goal in efforts to regulate psychotherapy. The international comparison also shows that psychotherapy will survive but not flourish if it remains only in the hands of doctors and psychologists as a method or specialisation. [ABSTRACT FROM AUTHOR]

L'unité régionale de soins aux auteurs de violences sexuelles a vu le jour à Lille, en 2009, sous l'impulsion du Docteur Tiphaine Séguret, et sous l'égide de l'Agence Régionale de Santé des Hauts-de-France. Elle est hébergée par le Centre Hospitalier Universitaire de Lille. Cette unité est née de l'impérieuse nécessité de créer et coordonner des soins spécifiques incluant les dimensions psychocriminologiques et sexocriminologiques, dans une articulation au carrefour de la Santé et de la Justice. À l'origine dédiée aux sortants de prison condamnés pour des infractions à caractère sexuel, cette unité a connu une diversification protéiforme, à mesure de la découverte des nombreux cas de figure et problématiques qui lui étaient confiés. Exerçant aujourd'hui de la pédiatrie jusqu'aux institutions pour personnes âgées dépendantes, l'URSAVS a ouvert la voie à une réflexion de fond sur les méthodes et pratiques de soins spécifiques aux auteurs de violences sexuelles. Ses résultats en matière de prévention de la récidive à cinq ans (1 %) montrent une efficacité durable de son paradigme de soin, rapportée aux statistiques nationales de récidives sur la même durée (15 % pour les viols, 11 % pour les agressions sexuelles, 12 % pour les harcèlements sexuels, selon le ministère français de la Justice). The regional unit for the care of perpetrators of sexual violence (URSAVS) was established in Lille in 2009, under to the impetus of Doctor Tiphaine Séguret, and under the aegis of the Regional Health Agency of the department of Hauts-de-France. It is hosted by the University Hospital of Lille. This unit was born out of the urgent need to establish and coordinate specific care services including psycho- and sex-criminological dimensions, at the crossroads of mental health service and judicial entities. Originally destined for those who had been convicted of sexual offences and who were being released from prison, this unit has diversified in many ways, as the many cases and problems entrusted to it were discovered. Operating today in the realms of pediatrics, care of the elderly, and including the National Education system, URSAVS has paved the way for a fundamental reflection on the methods and practices of care specific to perpetrators of sexual violences. Its results in the prevention of recidivism after 5 years (1%), demonstrate the lasting effectiveness of its paradigm of care, especially when compared to national statistics on recidivism over the same period (15% for rape, 11% for sexual assault, 12% for sexual harassment, according to the French Ministry of Justice). [ABSTRACT FROM AUTHOR]

Quel est le sujet de la psychiatrie ? Professionnelles du service de psychiatrie de l'hôpital d'instruction des armées Sainte-Anne à Toulon, nous avons eu l'idée de formuler une première réflexion à trois, entre psychomotricienne, psychologue et psychiatre, autour du soin en psychiatrie, en supportant les nuances voire les divergences de nos pratiques. Notre présent travail ne prétend pas mener à une pensée univoque ; il s'impose d'une volonté de soutenir la nécessité d'une continuité des soins, du travail en commun, du décloisonnement des différents espaces où est entendu le sujet, devant la discontinuité qui touche aujourd'hui la psychiatrie en France. Notre fil rouge sera le transfert comme instrument nécessaire pour que puisse se produire dans la rencontre une parole inédite. What is psychiatry about? As professionals in the Department of Psychiatry of the Sainte-Anne Army Hospital in Toulon, we decided to formulate an initial three-way discussion between psycho-motor specialists, psychologists and psychiatrists on the subject of psychiatric care, bearing in mind the nuances and even the divergences in our practices. Our current work does not claim to lead to unequivocal thinking; it is based on a desire to support the need for continuity of care, for working together, and for decompartmentalizing the different areas where the subject of psychiatry is relevant, especially in light of the discontinuity that is present in the practice of psychiatry in France today. Our common thread will be transference as a necessary element so that this encounter can develop an unprecedented form of expression. [ABSTRACT FROM AUTHOR]

La recherche est-elle nécessaire au soin en psychiatrie ? Pourrait-elle au contraire s'avérer contre-productive, et réduire son champ par le réductionnisme inhérent à sa méthodologie ? Sont dépliés dans cet article les spécificités du soin en psychiatrie, à travers l'histoire de notre discipline et son lien étroit avec la recherche clinique comme fondamentale. Ses principaux axes de développement sont ensuite détaillés au regard de leur impact sur le soin, puis est discutée, à la lumière des enjeux éthiques et épistémologiques de la discipline, la compatibilité entre la question du soin, dont l'essence même est de veiller au bien-être du sujet, et celle de la quête d'un savoir, qui vise souvent d'abord l'intérêt collectif et indirectement le soin individuel, sans pour autant en constituer le garant. Is research necessary for psychiatric care? On the contrary, could it prove to be counter-productive, reducing the scope of the field by the reductionism inherent in its methodology? This article examines the specific features of care in psychiatry, from the point of view of the history of our discipline and its close links with both clinical and fundamental research. Its main lines of development are then detailed, viewed through the lens of the ethical and epistemological challenges facing the discipline, in terms of their impact on care, and the compatibility between the question of care, and that of the quest for knowledge. The very essence of the former being to look after the subject's well-being, whereas that of the latter is often aimed primarily at the collective interest and indirectly at individual care, without necessarily guaranteeing it. [ABSTRACT FROM AUTHOR]

Dans cette communication, nous montrons que la littérature sur la prévalence des troubles psychiatriques et liés à l'usage de substances en milieu pénitentiaire est riche. Son interprétation se heurte toutefois à plusieurs difficultés : (i) une grande hétérogénéité des systèmes judiciaire et de soins de santé mentale entre les pays et (ii) des spécificités de l'environnement carcéral parfois négligées dans la méthodologie des études. Forts de ce constat, nous développons les résultats d'un certain nombre de travaux de référence sur la prévalence des troubles psychiatriques et liés à l'usage de substances dans les prisons françaises. Nous discutons enfin les perspectives en termes d'épidémiologie psychiatrique en milieu pénitentiaire. In this paper, we show that the literature on the prevalence of psychiatric and susbtance use disorders in prisons is substantial. However, there are a number of difficulties one encounters in interpreting this literature: (i) there is considerable heterogeneity between countries' judicial and mental health care systems, and (ii) the specific features of the prison environment are sometimes overlooked in the methodology used to conduct such studies. With this in mind, we discuss a number of benchmark studies on the prevalence of psychiatric and substance use disorders in French prisons. Finally, we discuss the perspectives for psychiatric epidemiology in prisons. [ABSTRACT FROM AUTHOR]

Plusieurs études épidémiologiques témoignent des problématiques de santé mentale chez les personnes incarcérées. En France, le Plan Psychiatrie et Santé Mentale de 2011 à 2015 considère l'entourage du malade comme ressource essentielle à la fois pour l'évaluation, l'accompagnement et le rétablissement du patient. Cette étude a pour objectif principal d'analyser la place actuelle de l'entourage des patients dans les prises en charge psychiatriques en prison et plus particulièrement au sein des Structures d'Accompagnement vers la Sortie de prison. Il s'agit d'une étude qualitative multicentrique menée auprès de 16 professionnels de santé travaillant dans les quatre Structures d'Accompagnement vers la Sortie de effectives au moment de la réalisation de l'enquête. Actuellement, l'entourage reste peu associé au parcours de soins psychiatrique ambulatoire du patient en milieu pénitentiaire. On observe une absence de tout contact avec les proches dans la majorité des cas. Ce résultat contraste avec la volonté des professionnels de santé d'intégrer les proches dans leurs pratiques car les soignants considèrent l'entourage comme un pilier essentiel pour le rétablissement du patient. Il existe de nombreux bénéfices à intégrer l'entourage au parcours de soins du patient incarcéré mais aussi des limites à cette intégration. Les Structures d'Accompagnement vers la Sortie apparaissent comme des structures propices à l'inclusion des proches dans les pratiques des professionnels. L'intégration de l'entourage dans les prises en charge peut être mise en place par la réalisation d'actions concrètes, établies dans cette étude, afin de proposer une offre de soins optimale et une prise en charge globale du patient. A specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison. This study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as "SAS" in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled. Sixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients' entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care. Currently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrating family and friends into care can be achieved by taking the concrete steps set out in this study, in order to provide optimum care and overall patient management. [ABSTRACT FROM AUTHOR]

A recent review of the literature has shown that one of the reasons for excess mortality among people with mental disorders is less access to somatic care (Gandré et al., 2022). This article explores the testimonial injustices by people living with mental health problems and their repercussions on their somatic care, through analyzing the accounts of people affected by mental disorders, psychiatric caregivers and nursing students. It also proposes a device to bring (future) caregivers to question their own practices regarding the testimonial injustices experienced by people with mental disorders. Finally, it is an opportunity to think about addressing this theme in pre- and post-graduate healthcare training to improve the cares of people concerned by this issue. [ABSTRACT FROM AUTHOR]

A first Assessment and Orientation Center (CAdEO) was created in Lyon at the beginning of June 2020 in order to facilitate access to mental health care. This structure allows any person who requests it to access a psychiatric assessment within a few days. It does not implement a follow-up, but it allows the person to be quickly directed towards the structure or the professional, public or private, who will be able to provide the care he or she needs. The CAdEO relies on a multidisciplinary team, which includes psychiatrists, psychologists and nurses (including an advanced practice nurse), in order to provide a adjusted assessment and orientation. It opens from Monday to Friday. The CAdEO, which is located in the city center, works in close partnership with the general practitioners in its health territory, as well as with all the health, medico-social and social services involved in the field of mental health. Among its consultants, about 4 out of 5 people are referred to private practice or associations. One person out of five is referred to other services in the general psychiatric sector, of which the CAdEO is the entry point. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children’s mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as “online learning is harmful,” should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence. [ABSTRACT FROM AUTHOR]

L'accès aux études médicales odontologiques, pharmaceutiques ou de sage-femmes a été ouvert à des candidats n'ayant pas effectué de première année en sciences médicales depuis l'arrêté du 26 mars 1993 abrogé et remplacé par l'arrêté du 26 juillet 2010. Cette procédure « passerelles » relative aux modalités d'admission directe en deuxième ou troisième année d'études a connu différentes modifications jusqu'à aujourd'hui. Le cadre réglementaire prévoit l'accès à ce dispositif, entre autres, aux titulaires du diplôme de Master. Les psychologues (nécessairement détenteurs d'un diplôme de Master) sont éligibles à ces dispositifs permettant l'intégration aux études médicales. Les psychologues intéressés peuvent ainsi envisager la perspective d'une carrière médicale en reprenant leurs études en milieu ou fin de premier cycle universitaire. Dans cet entretien avec Jean-Pierre Bouchard, les psychologues Sarah Thierrée, Josué Masson et Théo Lemonnier échangent autour de leurs expériences. Ils présentent le dispositif, ses apports, ses limites, ainsi que les difficultés et satisfactions qu'ils ont rencontrées en empruntant cette nouvelle voie. Access to medical, pharmaceutical dentistry or midwifery studies has been opened to candidates who have not completed a first year in medical sciences since the decree of March 26, 1993 repealed and replaced by the decree of September 2, 2010. This "gateway" device relating to the procedures for direct admission to the second or third year of studies has been subject to various modifications until the decree of July 29, 2022. The regulatory framework provides for access to this device by holders according to their initial training. Among them is the Master's degree. Thus, psychologists (necessarily holders of a Master's degree) are eligible for these systems allowing integration into medical studies. Psychologists can thus consider the prospect of a medical career by resuming their studies in the middle or at the end of their first university cycle. In this interview with Jean-Pierre Bouchard, psychologists Sarah Thierrée, Josué Masson and Théo Lemonnier discuss their experiences. They present the device, the contributions, the limits, as well as the difficulties and satisfactions they may have encountered during their experience. [ABSTRACT FROM AUTHOR]

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Il n'est pas si fréquent que nous ayons un psychiatre élu à l'Assemblée Nationale. Comment les voix de la psychiatrie, de la psychologie, et plus globalement du soin dans toutes ses dimensions peuvent-elles être portées dans l'hémicycle afin d'entraîner des actions favorables sur le terrain ? Le docteur Brahim Hammouche, gériatre, mais aussi psychiatre, élu député de la 8ème circonscription de Moselle, a accepté de témoigner de son expérience de praticien évoluant depuis cinq ans dans l'univers législatif. En plus de ses commentaires concernant le rapport parlementaire dédié à la santé mentale qu'il a présidé, notre confrère nous fait part de ses réflexions eu égard aux perspectives pour la psychiatrie et la psychologie de demain dans notre pays. La place de la pathologie psychiatrique qu'on appelait autrefois « la folie » reste encore extrêmement difficile, douloureuse, notamment car des formes de stigmatisation perdurent. Or il y a aujourd'hui 13 millions de Français confrontés à la maladie psychiatrique, soit un citoyen sur cinq. Si l'on regarde la courbe de l'espérance de vie de sujets atteints de troubles psychiatriques, elle est aujourd'hui 16 ans de moins que les citoyens qui n'en souffrent pas. Alors, par rapport aux dépenses de santé mentale, nous sommes aujourd'hui au premier poste de dépenses pour l'assurance maladie à presque 23 milliards d'euros, ce qui est conséquent et constitue le premier poste de dépenses d'assurance maladie devant les maladies cardiovasculaires et devant les cancers (pour un total de 237 milliards d'euros). De surcroît sur le plan organisationnel, il conviendrait que l'administration ne se fasse pas en monocéphale administro-centré qui donnerait une parole extrêmement contrainte budgétairement en proposant simplement des « indicateurs de qualité ». Ainsi, lorsqu'une institution ne favorise pas la libération de la parole, elle entre hélas dans un système de maltraitance. Faciliter la circulation de la parole entre tous, les patients, leur famille, les soignants, les administratifs, est cardinal. Pour nous, professionnels de la vie psychique, il nous faut nous battre contre des décisions et des orientations prétendant à l'inexistence d'une vie psychique. On ne peut réduire simplement la vie à la communication, aux conduites ou aux interactions. La vie psychique est composée de désirs, de folies, de fantasmes, de pulsions, d'éléments qui dans l'état actuel des données de la science ne sont pas démontrables scientifiquement mais qui dans le quotidien, la proximité, le terrain, et l'écoute, montrent qu'elle existe réellement. Mettons au défi n'importe quelle IRM de démontrer le contraire ! Il faut rappeler que nous sommes encore dans un « bricolage », certes qui peut parfois braquer nos administrations et nos politiques de santé publique, mais nous sommes toujours dans un « bricolage anthropologique ». Nous sommes d'abord pragmatiques et nous adaptons nos pratiques cliniques, notre boîte à outil, à la personne humaine qui est en face de nous. Et, si on fait confiance un peu à la liberté, si on croit au libre-arbitre, l'homme est capable aussi d'autres choses que simplement de répondre à des normes. Nous sommes dans une période où les connaissances évoluent très vite avec une accélération du temps, un foisonnement des données et une complexification des savoirs : il y a un impératif à travailler en équipe. A un moment donné, quand un patient a besoin d'un type de prise en charge, on le lui propose. Dans une équipe, il faut qu'on ait la capacité de construire des thérapies différentes et de proposer à un patient, à un moment donné de son histoire, des orientations adaptées, des soins différents, mais souvent complémentaires. Les rapports parlementaires se multiplient, les conclusions se suivent. Les sujets de santé mentale ne sont pas forcément ceux qui viennent en priorité, tant au niveau parlementaire qu'au niveau du ministère de la santé. Il y a eu une nomination d'un délégué ministériel ce qui est une avancée... peut-être aurons-nous un jour un délégué interministériel. Aussi, nous avons proposé la création d'un Institut National de la Santé Mentale, sur le modèle de l'Institut National sur le Cancer, pour qu'il y ait un niveau d'investissements pluriannuels et une ligne directrice sur des programmes de 5 à 10 ans. Enfin, dernière note d'optimisme, eu égard au financement des séances de psychothérapies, nous sommes partis de presque rien : ce qui était impossible en 2017 devient possible en 2022. Et, maintenant, nous l'avons inscrit et voté dans le budget de la loi de financement de la sécurité sociale pour le printemps 2022 : il y aura possibilité d'avoir un remboursement de 30 euros chez un psychologue. Concernant les modalités, cela restera perfectible à l'usage. It is not so often that we have a psychiatrist elected to the National Assembly. How can the voices of psychiatry, psychology, and more generally care in all its dimensions be brought to the assembly in order to bring about favorable actions in the field? Doctor Brahim Hammouche, a geriatrician, but also a psychiatrist and an elected deputy for the 8th district of Moselle, France, has agreed to testify to his experience as a practitioner who has spent the past five years in the legislative universe. In addition to his comments on the dedicated parliamentary report on mental health that he chaired, our colleague shares his thoughts regarding the prospects for tomorrow's psychiatry and psychology in France. The place of psychiatric pathology, which was once called "madness," is still extremely difficult and painful, especially because forms of stigmatization persist. However, today there are 13 million French people confronted with psychiatric illness, i.e. one in five citizens. The life expectancy of subjects suffering from psychiatric disorders is 16 years less than that of the general public. Annual spending on mental health care accounts for almost 23 billion euros, making mental health the most expensive item in the national budget, ahead of cardiovascular disease and cancer (for a total of 237 billion euros). We should be wary of the risks of a single-headed administrative monster that proposes only "quality indicators." Also, when an institution does not promote the liberation, the expression, and the incarnation of discourse, it enters into a system of mistreatment. Developing this speech, and facilitating its circulation among everyone -- patients, their families, caregivers, administrators -- is essential. As professionals of psychic life, we have to fight against decisions and orientations that claim that psychic life does not exist. Life cannot simply be reduced to communication, behaviors, or interactions. Psychic life is made up of desires, follies, fantasies, impulses -- elements that in the current state of scientific data are not scientifically demonstrable but that everyday life, proximity to patients, and the work of listening "on the ground" show to be real. Let's challenge any MRI to prove the opposite! It should be remembered that we are still in a stage of "tinkering," which can certainly sometimes antagonize our administrations and our public health policies, but we are still in a moment of "anthropological tinkering." We are, above all, pragmatic and we adapt our clinical practices, our toolbox, to the human person in front of us. And, if we trust freedom a little, even if we believe in free will, humanity is also capable of more than simply meeting standards. Because we are in a period where knowledge is evolving very quickly with an acceleration of time, an abundance of data, and a complexification of knowledge, there is an imperative to work as a team. At some point, when a patient needs a particular type of care, it is offered to them. In a team, we must have the ability to build different therapies and to offer a patient appropriate orientations, different but often complementary forms of care. Psychiatric patients are not necessarily subjects that come first, neither at the parliamentary level nor at the level of the Ministry of Health. There was an appointment of a ministerial delegate, which is a step forward... perhaps one day we will have an interministerial delegate. Also, we also proposed the creation of a National Institute of Mental Health, based on the model of the National Institute of Cancer, to ensure multiannual investments and a guideline on 5- to 10-year programs. Finally, the last note of optimism, with regard to the financing of psychotherapy sessions, we started from almost nothing: what was impossible in 2017 became possible in 2022. And, now, we have included and voted it in the social security budget for spring 2022: the possibility of reimbursing 30-euro psychotherapy sessions. Regarding the terms, they will be perfected with experience. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec 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.)

Many music therapists working in hospitals across Canada have continued to provide direct in-person care throughout the COVID-19 pandemic. In this reflection on practice article, the authors share clinical perspectives on the provision of music therapy services on inpatient mental health units, discussing the various ways in which music therapists navigated restrictions and creatively adapted music therapy services to support inpatient mental health care during the first year of the COVID-19 pandemic. These reflections illustrate how the COVID-19 pandemic has impacted the work of music therapists and offer insights into methods for reimagining music therapy practice. [ABSTRACT FROM AUTHOR]

Cette étude associe la méthode d'analyse conceptuelle et la méthode clinique psychopathologique et psychiatrique pour élucider les fonctions de l'anticipation. La signification du terme anticipation a évolué au cours du temps en fonction des courants philosophiques. C'est à la charnière des XIXe et XXe siècles que l'accent sera mis sur l'anticipation comme processus de pensée, opération de l'esprit générant une action de représentation de concepts, de théories ou de conduites, d'actes futurs dirigés vers un objet à construire. L'anticipation est à la fois un acte de pensée et une conduite ; il ne s'agit pas d'un processus statique et les fonctions de l'anticipation ne s'analysent pas à partir des mêmes critères selon que l'on évoque l'individuel ou que l'on se réfère au collectif, que l'on s'attache au réel ou au virtuel, que l'on explore le monde du vivant ou le monde physique. L'auteur analyse ici les particularités de la pensée anticipatrice dans la clinique psychopathologique et psychiatrique ainsi que l'impact de l'intrication entre image manifeste et image scientifique décrites par Wilfrid Sellars. L'auteur rappelle l'apport du Pr Sutter sur l'incapacité d'anticipation chez les patients dépressifs, ses propres analyses de l'anticipation parentale, des capacités d'anticipation de l'enfant et des défaillances dans les troubles psychiques. Il apparaît dans ces cadres une primauté de l'image manifeste de l'homme dans les relations à autrui et une primauté de l'image scientifique de l'homme dans les constructions théoriques que nous opérons dans l'objectif d'une anticipation créative. L'image manifeste de l'homme apparaît alors comme l'un des référents de la pensée qui freine ou au contraire dynamise tout processus d'anticipation dans la mesure où s'y infiltrent aussi des éléments de l'image scientifique. Dans tous les domaines, l'anticipation recoupe divers aspects, analysés en référence au langage utilisé, commun ou spécialisé. Il en résulte la création de systèmes anticipatifs représentant tous les secteurs de la connaissance et la nécessité d'avoir recours à la méthode analytique. Anticiper dans le cadre de la santé mentale c'est, à la fois, s'appuyer sur l'image manifeste de l'homme de notre temps et projeter l'image scientifique de l'homme dans un temps à venir, dont nous ne concevons pas encore les limites techniques, idéologiques et sociétales. C'est aussi se demander quels seront les nouveaux objets de pensée dans un horizon lointain. This study combines the conceptual analysis method and the psychopathological and psychiatric clinical method to elucidate the functions of anticipation. The meaning of the term anticipation has evolved over time according to philosophical currents. It is at the turning point of the 19th and 20th centuries that the emphasis will be placed on anticipation as a process of thought, an operation of the mind, generating an action of representation of concepts, theories or conduct, of future acts directed towards an object to be built. Anticipation is both an act of thought and a conduct; it is not a static process and the functions of anticipation are not analyzed on the basis of the same criteria according to whether the individual is evoked or referred to as the collective, whether we focus on the real or the virtual, whether we explore the world of life or the physical world. The author analyses here the peculiarities of anticipatory thinking in the psychopathological and psychiatric clinic as well as the impact of the entanglement between manifest and scientific images described by Wilfrid Sellars. The author recalls the contribution of Professor Sutter on the inability to anticipate in depressed patients, his own analyses of parental anticipation, the child's ability to anticipate and failures in mental disorders. It appears in these settings a primacy of the manifest image of man in relations to others and a primacy of the scientific image of man in the theoretical constructions that we operate with the objective of a creative anticipation. The manifest image of man then appears as one of the referents of thought that restrains or, on the contrary, energizes any anticipatory process insofar as elements of the scientific image also infiltrate it. In all fields, anticipation intersects various aspects, analysed with reference to the language used, common or specialized. The result is the creation of anticipatory systems representing all sectors of knowledge and the need to use the analytical method. To anticipate in the context of mental health is, at the same time, to rely on the manifest image of the man of our time and to project the scientific image of the man in a future time, of which we do not yet conceive the technical, ideological and societal limits. It is also to wonder what new objects of thought will be on a distant horizon. [ABSTRACT FROM AUTHOR]

Context: Training of health and social support professionals in recovery-oriented approaches to mental health has been developing in France for about ten years. Few of them have been described in terms of their effects on participants. Aim: What are the effects of a training pathway for health professionals aimed at 1) the acculturation of professionals to the notion of recovery in mental health; 2) the transmission of the characteristics of this process and 3) the related change in practices. Participants: For five years (2013–2017), 363 professionals benefited from 25 training sessions on the theme of supporting people's recovery in the health, social and disability fields. Method: The verbatim, collected by means of open-ended questionnaires, was subjected to lexical analysis using Iramuteq software. Results: The lexical analyses show that according to the participants, such a training system would make it possible to achieve the objectives of (1) acculturation (raising awareness), (2) transmission of the characteristics of this personal process (making people understand) and (3) support for change in practices induced in the recovery-oriented approach (practising). Conclusion: The training of health professionals in recovery-oriented approaches must be the subject of more research in medical pedagogy and social sciences in France, in order to facilitate the deployment and evaluation of practices in mental health and psychiatry. [ABSTRACT FROM AUTHOR]

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L'objectif de cet article est de présenter une revue de la littérature concernant les risques psychiatriques liées à la pandémie de la Covid 19, en population pédiatrique. Une revue de littérature a été réalisée sur la base de données Pubmed avec les mots clés : Covid 19, coronavirus, enfant, adolescent, santé mentale, conséquences psychiatriques et/ou psychologiques (Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences). Nous présentons un état des lieux des recherches actuelles en fonction de trois facteurs : la crainte liée à la pandémie, les séquelles psychiques du confinement et les risques de traumatismes cumulatifs. Nous présenterons trois vignettes cliniques d'enfants ayant été suivi pendant la crise sanitaire suite au développement de symptômes liés à cette situation exceptionnelle. Nous terminerons par des perspectives sur la gestion de la crise sanitaire par les services de psychiatrie de l'enfant et de l'adolescent. The objective of this article is to present a literature review concerning the psychiatric consequences associated with the Covid 19 pandemic, in the pediatric population. This review is realized with Pubmed Database, using Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences as keywords. We propose to present an inventory of current research based on three factors: fear linked to the pandemic, the consequences of the stay-at-home confinement, and the risks of cumulative trauma. We will present three clinical vignettes of children who were followed during the health crisis following the development of symptoms related to the health situation. We will end with some perspectives on the management of the health crisis by child and adolescent psychiatry services. [ABSTRACT FROM AUTHOR]

L'accès à la connaissance – les moyens d'y parvenir et les débats qui l'entourent – reste l'une des interrogations qui persiste à travers les temps. Le propos central de cet article est l'analyse des éléments qui interviennent dans la passion de la connaissance. L'auteur propose une conception de ce qui peut devenir « passion de la connaissance » à partir de stimulations et d'états mentaux précoces et de la dynamique des interactions. Cette passion s'organise autour de trois actions : découvrir, connaître, transmettre, avec, comme supports, la curiosité et l'apprentissage. Ceci est illustré par des exemples reconnus historiquement, la poétesse et théologienne Juana Inès de la Cruz (XVIIe s.), le pianiste et essayiste Glen Gould, le designer et théoricien de la couleur J. Itten. Deux cas cliniques suivis par l'auteur témoignent des dérives de cette passion. La connaissance recouvre plusieurs secteurs disciplinaires et se dirige vers diverses orientations en mobilisant différentes dimensions de la cognition mais se heurte toujours à la question de la certitude et à l'acceptation de l'incertitude. Access to knowledge, the means to achieve it and the debates that surround it remain one of the questions that persist throughout time. The central theme of this article is the analysis of the elements involved in the passion for knowledge. The author proposes a conception of what can become a "passion for knowledge" from early mental states and stimulations and the dynamics of interactions. This passion is organized around three actions: to discover, to know, to transmit with as supports curiosity and learning. Access to knowledge, the means to achieve it and the debates that surround it remain one of the questions that persist throughout time. This is illustrated by historically recognized examples, the poetess and theologian Juana Inès de la Cruz (17th century), the pianist and essayist Glen Gould, the designer and theorist of color J. Itten. Two clinical cases followed by the author testify to the drifts of this passion. Knowledge covers several disciplinary areas and is directed at various directions by mobilizing different dimensions of cognition but always runs up against the question of certainty and acceptance of uncertainty. [ABSTRACT FROM AUTHOR]

The goal of this phenomenological study was to document the practice of music therapy in adolescent mental health, more specifically through brief group therapy sessions involving this age group. Despite proven needs in this population and the promising effects of music therapy as confirmed by mental health research, the Canadian literature contains scant documentation about this specific context. This study, in the form of semi-structured interviews, sought to learn about the professional experience of three Canadian music therapists who work primarily with adolescents who have mental health issues. An analysis of their responses revealed three main themes: (a) the primary goals in this type of context, (b) the program structures generally established, and (c) the professional skills required. While specific approaches are required for groups of adolescents who present with psychiatric and psychosocial problems, each music therapist uses their own specific work methods, which can therefore vary greatly from one practitioner to the next. The study highlights, in particular, the importance of community music therapy, as well as the need to value individuality--each person's unique story--in the therapeutic process. [ABSTRACT FROM AUTHOR]

Résumé: En 1999, le Pôle de Psychiatrie du CHU de Saint-Étienne se saisit de la Loi Aubry contre les exclusions et met en place un dispositif novateur en créant « Interface », première Équipe Mobile Psychiatrie Précarité du département de la Loire. Après avoir repris le contexte de création de ce dispositif « d'aller-vers », des vignettes cliniques illustrent combien le travail de cette équipe d'accès aux soins tente de lutter contre les discriminations dans le champ de la santé. In 1999, the CHU Saint-Etienne psychiatry center took advantage of the anti-exclusion Aubry law to implement an innovative project "Interface", the first Precarity Psychiatry Mobile Team in the Loire department (France). After reviewing the background to the creation of this system, clinical vignettes illustrate the extent to which the work of this health care access team attempts to combat discrimination in the field of health care. [ABSTRACT FROM AUTHOR]

This article addresses the theme of diagnostic reduction in psychiatry, a process by which necessarily complex and multifactorial situations are reduced to medical conditions. This process presents obvious pitfalls, but also certain functions, in particular that of circumscribing what the psychiatric judgment can legitimately or not focus upon. In parallel, I will discuss the distinctions between narrative and pathological suffering, as well as the moral and medical judgments that may be associated with them. This will lead me to argue in favour of a pragmatic attitude with regard to psychiatric diagnostic classification, i.e., with regard to the standardized term used to categorize and identify so-called mental health disorders. I will then highlight the implications for clinical practice, notably that a transparent discussion of these aspects with certain patients can benefit the therapeutic relationship and allow people with mental disorders to envisage a narrative that does not have to be limited to a psychiatric condition or be constituted by the rejection of the latter, but which can leave it a legitimate place. Ultimately, I hope that raising clinicians’ awareness of the ethical issues inherent in psychiatric diagnosis will limit the potentially pejorative and dehumanizing nature of diagnostic reduction, by allowing them to adopt reflexive and transparent attitudes on these issues. [ABSTRACT FROM AUTHOR]

Transcultural psychiatry is at the confluence of culture, mental health and illness. It places the patient at the centre of the relationship while respecting his or her individual and collective way of thinking and doing. Culture defines ontological representations, explanatory models and therapeutic practices which influence expressions of suffering and specific modes of coping and healing, as diverse as the cultures from which they arise. Yet, Western psychiatry is just as indivisible from the culture from which it emerged, which brings up the question of mental suffering and care in transcultural situations. Transcultural psychiatry brings the clinician to question and widen his or her clinical practice with regards to social, geopolitical and historical issues which colour the bonds in the social fabric, in power imbalances and in access to health care for individuals of cultural minorities. How can we make our consultations with patients from different parts of the world and who speak different languages ethical? How should one care for patients when faced with cultural otherness? And what are the effects on the mental health of today’s youth, who are raised in global societies which generate complex identity challenges that can lead to radicalization? This article offers some answers to these clinical and ethical questions through the hybridization of representations, in order to ensure a harmonious coexistence and a renewed creativity, for an “ethos of solidarity” in mental health care. [ABSTRACT FROM AUTHOR]

Background: In psychiatry, the issue of providing palliative and endof-life care for what would be a “terminal psychiatric condition” or considering a palliative approach to severe and persistent mental health problems is still a taboo. Methodology: This question is addressed through an analysis of a case arising during a clinical ethics consultation, using Hubert Doucet’s scenario method. It is about Mrs. Sanchez, a patient over 90 years of age with a psychiatric profile, expressing the desire to die by suicidal gestures, refusing the proposed treatments, and refusing as well to drink and eat. Her clinical history is told through the filter of reflexive support offered in clinical ethics to the various stakeholders. Results: The case analysis, far from responding to the challenges posed by the concept of palliative and end-of-life care in a psychiatric context, nevertheless presents an opportunity to name its main ethical issues: psychic suffering, refusal to eat and drinking as well as refusal of treatment, palliative sedation and medical assistance in dying, wishes and advanced medical directives and clinical-organizational challenges for geriatric psychiatry clients. Conclusion: There are still many challenges for professionals and decision-makers to meet the needs of older mental health clients. We call for further development of knowledge on this specific topic. [ABSTRACT FROM AUTHOR]

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Analyser la place de l'hystérie en comparant les nosographies psychiatriques et les conceptions psychanalytiques du XXIe siècle dans les différents modèles classificatoires témoignant de critères diagnostiques très hétérogènes et ne rendant pas le travail d'équipe pluridisciplinaire aisé. Revue de la littérature pour analyser la place et l'évolution de la névrose hystérique dans les nosographies psychiatriques internationales et nationales (DSM, CIM-10, CFTM) d'un côté, et psychanalytiques de l'autre (PDM, approches structurales de Bergeret et Lacan, approches processuelles de Roussillon et Benedetti). Nous observons une disparition progressive de l'hystérie et de la névrose dans les évolutions successives du DSM-III au DSM-5, son éclatement en plusieurs troubles dans la CIM-10 qui va rendre la pose d'un diagnostic commun problématique en équipe clinique pluridisciplinaire. Au contraire, l'hystérie conserve sa place dans toutes les nosographies psychanalytiques. Le clivage entre la nosographie psychiatrique du DSM-5 (malgré le début d'intégration d'une perspective dimensionnelle) et les nosographies psychanalytiques semble de plus en plus marqué dans le champ de la névrose. Il faut relever également qu'à l'intérieur du champ psychanalytique, il existe plusieurs conceptions de l'hystérie comme névrose ou comme structure de personnalité pouvant fonctionner sur un mode adaptatif ou décompensé (Bergeret). La multiplicité des modèles théoriques élaborés pour la comprendre a débouché sur une extension transnosographique de l'hystérie puisque plusieurs auteurs (Roussillon, Benedetti) avancent qu'on peut trouver des noyaux hystériques dans les troubles narcissiques plus sévères. S'il apparaît difficile de construire un modèle intégrant toutes les dimensions anthropologiques, psychodynamiques et biologiques de l'hystérie permettant de déboucher sur une approche consensuelle sur le plan diagnostique en équipe clinique, la pluralité des modèles théoriques construits à l'intérieur du champ psychodynamique offre à chacun des cliniciens des points de repère utiles pour la comprendre et la prendre en charge. The aim of this study is to focus on the place of hysteria in psychiatric nosographies and the psychoanalytic conceptions of the 21st century, across the different classification models: the diagnostic criteria are very heterogeneous, and this does not facilitate pluridisciplinary teamwork. A literature review to analyse place and evolution of hysterical neurosis in national and international psychiatric nosographies (DSM, ICD10, CFTM) and in psychoanalytic conceptualizations (PDM, the structural approaches of Bergeret and Lacan, the processual approaches of Roussillon and Benedetti). We note a gradual disappearance of hysteria and neurosis in successive versions of the DSM, from DSM-3 to DSM-5. Hysteria is broken down into several disorders in the ICD10. This makes it more difficult to reach a consensual diagnosis in a clinical team. Conversely, hysteria has retained its founding and fundamental place in all psychoanalytical nosographies. The divide between the American DSM-5 psychiatric nosography and psychoanalytical nosographies seems increasingly marked in the field of neuroses, despite the beginnings of an integration of a dimensional perspective. We can also note the plurality of views of hysteria within the psychoanalytic field. Authors present hysteria either as a neurosis or as a personality structure that is able to function on an adaptive or decompensated mode (Bergeret). The plurality of theoretical models constructed to understand hysteria has resulted in a transnographic extension of hysteria, since several authors (Roussillon, Benedetti) postulate that it is possible to find hysterical elements in the most severe narcissistic disorders. While it seems difficult to construct an integrative model including the anthropological, psychodynamic and biological dimensions of hysteria, making it possible to reach a consensual diagnosis in a clinical team, the numerous theoretical models in the psychodynamic field provide each clinician with useful benchmarks to understand and to manage hysteria. [ABSTRACT FROM AUTHOR]

La « désinstitutionalisation » a pénétré les politiques publiques françaises en matière de santé mentale, et un retour sur la polysémie du terme d'institution est nécessaire afin que la psychiatrie française ne perde pas le lien à son histoire et puisse continuer à innover dans son organisation. Dans le cadre de notre recherche de doctorat, nous avons conduit une étude de documents portant sur des articles provenant de plusieurs disciplines des sciences humaines et sociales, ainsi que sur le corpus de la psychothérapie institutionnelle de 1952 à la fin des années 1990, afin de comprendre la polysémie et les divers usages du terme institution. Si la sociologie et l'économie institutionnaliste considèrent l'institution avant tout dans son sens statique, l'assimilant à un ensemble de règles régissant des comportements, une partie de la philosophie et de la psychologie clinique lui prête une vie et assimile plutôt l'institution à un écosystème, véritable organisme vivant. La spécificité française du sens du terme institution, pris avant tout comme un processus et non comme son résultat, a été mise à mal avec l'importation du sens anglo-saxon du terme, plus axé sur le bâti et confondu, dans le champ de la psychiatrie, avec l'hôpital psychiatrique lui-même. Dans un contexte de développement massif des réseaux et des partenariats entre structures sanitaires, médico-sociales et de droit commun, nous plaidons pour une réhabilitation du terme d'institution afin de penser une psychothérapie « trans-institutionnelle » connectée aux principe du secteur. "Deinstitutionalization" has penetrated French public policies in the field of mental health. Studying the polysemy of the term institution is thus once again necessary so that French psychiatry does not lose the sight of its history and can continue to innovate in the organisation of mental healthcare. As part of our doctoral research, we conducted a literature review of articles from several disciplines in the humanities and social sciences, as well as books and articles from the corpus of institutional psychotherapy (1952 to the late 1990s). While sociology and institutionalist economics consider the institution primarily in its static sense, assimilating it to a set of rules governing behaviours, some philosophers and clinical psychologists, on the contrary, tend to rather consider the institution as a living ecosystem. The particular meaning of the term institution in French psychiatry, taken above all as a process and not as its result, has been challenged with the import of the meaning of the term in English, where it is more focused on the material edifice and, in psychiatry, confused with the psychiatric hospital itself. In the setting of a massive development of networks and partnerships between healthcare, medico-social and common law structures, we plead for a rehabilitation of the term institution, in order to theorize a "trans-institutional" psychotherapy connected to the principles and history of the sector system. [ABSTRACT FROM AUTHOR]

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Background: The prevalence of tobacco smoking among people with severe mental illness (SMI) substantially exceeds smoking rates in the general population and has been identified as the largest contributor to health inequalities in this group. Historically deeply embedded in the culture of mental health treatment environments, smoking until very recently was the norm in inpatient settings and still prevails in many settings internationally. In England however, mental health Trusts are currently implementing recent national guidance, according to which mental health settings will become entirely smokefree, with no exemptions, providing comprehensive evidence-based support to patients for smoking cessation and smoking abstinence during the inpatient stay. Aim: The aim of this article is to summarise the rationale for and the debate surrounding smokefree mental health inpatient settings, and to review and discuss the evidence on challenges, opportunities and impact of smokefree policy implementation in these settings, with a focus on the English debate and experience to date. [ABSTRACT FROM AUTHOR]

Résumé Objectif Arthur Kleinman est professeur de psychiatrie, d'anthropologie médicale et d'anthropologie à l'université de Harvard. C'est une des figures majeures des champs de l'anthropologie médicale, de la psychiatrie transculturelle, de la santé globale et des humanités médicales. Son principal terrain d'étude est la Chine contemporaine. Outre de nombreux ouvrages collectifs et articles, il est l'auteur de plusieurs livres qui abordent ses thématiques de recherche. Le but de cet article est de mieux faire connaître ses travaux au lectorat français intéressé par les liens entre la médecine, la psychiatrie et les sciences sociales. Méthode L'article proposé ici est la retranscription, traduite de l'anglais, d'un entretien réalisé avec Arthur Kleinman en décembre 2017 au département d'anthropologie de l'université de Harvard. Résultats Il y retrace son parcours et développe ses thématiques de recherche : l'étude ethnographique de l'expérience des patients souffrant de maladies chroniques, les enjeux du diagnostic psychiatrique dans le champ de la psychiatrie transculturelle, l'approche de la santé globale à partir du champ théorique des sciences sociales, puis l'abord anthropologique du soin et sa place dans l'exercice de la médecine actuelle. Discussion Que peuvent apporter les sciences sociales à la médecine et à la psychiatrie ? Quelle est la situation de la santé mentale globale ? Quelle place occupe le soin dans la médecine actuelle ? Comment faire face à la logique gestionnaire qui la domine ? Conclusion Ces différentes questions sont abordées au travers du parcours et de l'engagement d'Arthur Kleinman pour l'ouverture du champ de la médecine et de la psychiatrie au champ des sciences sociales. Abstract Purpose Arthur Kleinman is Professor of Psychiatry, Medical Anthropology at Harvard Medical School and of Anthropology at Harvard University. He is a leading figure in medical anthropology, cultural psychiatry, global health and medical humanities. He is a China scholar. In addition to numerous collective works and articles, he has published six single authored books about his research. The purpose of this article is to make his work better known in France, for those interested in the links between medicine, psychiatry and the social sciences. Method The present article is the transcript, translated from English, of an interview with Arthur Kleinman, conducted in December 2017 at the Department of Anthropology at Harvard University. Results He tells about his career and develops his research themes: the ethnographic study of the illness experiences of patients suffering from chronic diseases, the issues of psychiatric diagnosis in the field of cultural psychiatry, the approach of global health from the social sciences' field, then the anthropological approach to care and its place in the contemporary medicine. Discussion What medicine and psychiatry should learn from the social sciences? What is the situation of global mental health? What is the place of care in contemporary medicine and how to deal with the economic logic that dominates it? Conclusion These different questions are approached through Arthur Kleinman's career and advocacy to open the field of medicine and psychiatry to the field of social sciences. [ABSTRACT FROM AUTHOR]

Copyright of Revista Criterio Libre is the property of Revista Criterio Libre 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.)

Objectives: 1) To describe clinical characteristics and outcomes of children referred for urgent psychiatric consultation to a Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC); and, 2) To study the association between referral source, clinical characteristics, and post assessment outcome. Method: This is a 12-month retrospective cohort study of children aged 4 to 12-years referred to a CAMHUCC. The clinic's electronic data base contains demographic and clinical information including reason for referral, diagnosis, and consult outcome. Study data were extracted and analyzed using descriptive statistics and Mann-Whitney U tests. Results: The study sample consisted of 120 children, 41.5% male, average age 9.03 years (SD=2.2). Fifty-percent were referred by Children's Mental Health Agencies (CMHA) and 31.7% by Emergency Departments. The most frequent reason for referral was aggression (64.1%). Most common diagnoses were externalizing disorders (76.7%). Thirty-percent had an identified learning disorder, 80% were referred back to the community and 14.2% were referred to outpatient clinic. There was a significant association between referral from an Emergency Department and female gender (p=0.048) and brief follow-up with CAMHUCC (p=0.006). Conclusion: Regardless of source of referral, the most common reason for urgent psychiatric referral was aggression and the majority of individuals did not require inpatient psychiatric care. Collaborative multiagency education in child and adolescent mental health disorders, including the role of learning disabilities in externalizing behaviors, may improve the capacity of CMHA and schools to identify and provide focused interventions that may, in turn, reduce behavioral crisis and visits to Emergency Departments and urgent clinics. [ABSTRACT FROM AUTHOR]

Résumé Objectif Depuis quelques années, le paysage psychiatrique français semble se réformer en s'orientant vers une approche communautaire du soin. Le but de cet article est de commenter cette évolution récente ainsi que l'impact de ces changements. Cela, à la lumière des liens que nos institutions psychiatriques ont tissés avec des organismes porteurs d'une vision globalisée de la santé mentale tels que l'Organisation mondiale de la santé. Méthode Au travers d'une revue de littérature réalisée sur un ensemble de 12 bases de données spécialisées, 41 articles, 15 textes législatifs, 13 rapports de l'Organisation mondiale de la santé et de la Haute Autorité de santé, 5 ouvrages et 1 communication ont été sélectionnés. Résultats L'évolution de nos institutions dévolues à la santé mentale sera commentée en isolant les leviers à l'origine de ces transformations insistant notamment sur ceux employés par l'Organisation mondiale de la santé. Ensuite, les principales conséquences théorico-pratiques découlant de la généralisation de la psychiatrie communautaire en France seront catégorisées en quatre parties distinctes. Discussion Les auteurs questionneront donc l'apparition de nouveaux éléments sémantiques visant une réduction de la stigmatisation de l'usager en santé mentale. Puis, ils discuteront des évolutions législatives facilitant l'établissement de politiques de santé mentale communautaires. De même, l'apparition, la diffusion et l'appropriation par les équipes de nouveaux concepts seront exposés. Enfin, la généralisation de nouveaux dispositifs d'accompagnement sera abordée en s'appuyant sur l'émergence récente des conseils locaux en santé mentale ou encore celle des groupes d'entraide mutuelle. Conclusion À terme, il sera question de l'évolution future de ces changements. Abstract Objective In recent years, the French psychiatric landscape seems to be shifting towards an approach that focuses on community care. The purpose of this article is to comment on this recent evolution as well as the impact of these changes. It is important to discuss because of the links that our psychiatric institutions have established with organizations entertaining a global view of mental health, such as the World Health Organization. Method Our article begins with a literature review of 12 specialized databases, 41 articles, 15 legislative texts, 13 reports from the World Health Organization and the Haute Autorité de santé , 5 books and 1 communication. Results The evolution of our institutions devoted to mental health will be examined by focusing on the levers underpinning these transformations, with particular emphasis on those used by the World Health Organization. Then, the main theoretical and practical consequences arising from the generalization of community psychiatry in France will be categorized into four distinct parts. Discussion We thus explore the emergence of new semantic elements aiming to reduce the stigmatization of the user in the area of mental health. We will then discuss legislative developments facilitating the instatement of community mental health policies. Similarly, the appearance, dissemination and appropriation by teams of new concepts will be described. Finally, the generalization of new support systems will be reviewed on the basis of the recent emergence of the Local Councils in Mental Health or the Mutual Assistance Groups. Conclusion Finally, the future evolution of these changes will be discussed. [ABSTRACT FROM AUTHOR]

Copyright of Trivium (2176-4891) is the property of Mestrado Profissional em Psicanalise, Saude e Sociedade da Universidade Veiga de Almeida 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.)

Introduction: The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods: A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results: Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion: Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion: Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. [ABSTRACT FROM AUTHOR]

Copyright of Ergoscience is the property of Schulz-Kirchner Verlag Gmbh 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.)

Résumé L’espoir et le rétablissement sont l’essence même de la pair-aidance. Celle-ci s’est développée avec le mouvement du rétablissement aux États-Unis dans les années soixante-dix, au cours duquel des patients se sont révoltés contre les pronostics fatalistes de certains médecins et ont commencé à témoigner de leur reprise de pouvoir sur leur vie. Le rôle du pair aidant est d’accompagner, à la fois les patients et le personnel de santé, vers un nouveau paradigme en santé et des pratiques professionnelles innovantes, afin de favoriser le processus de rétablissement des personnes. Promouvoir le rétablissement, c’est admettre qu’une personne peut avoir une maladie psychiatrique chronique sévère et vivre de façon épanouissante et heureuse. C’est considérer que l’évolution de la maladie et le devenir de la personne sont indépendants et que la préoccupation principale des patients est le rétablissement. C’est aussi admettre que, si le médecin peut soigner ou guérir, il ne peut « rétablir » la personne, c’est la personne qui peut « se rétablir », ce qui implique de favoriser l’empowerment et l’autodétermination du sujet, en reconnaissant son savoir expérientiel. Cet article étudie le concept du rétablissement, les étapes de son processus, les facteurs favorables et les attitudes soignantes adaptées. Il met en lumière la manière dont la pair-aidance peut aider au rétablissement et favoriser ce changement de paradigme et de postures en psychiatrie, déjà amorcé, où l’on se préoccuperait, au-delà de l’évolution de la maladie, du devenir de la personne et de sa reconstruction dans toutes les dimensions de sa vie, personnelle, affective et sociale, professionnelle, spirituelle, citoyenne… Les études ont montré que le métier de pair-aidant apportait de nombreux bénéfices pour les patients et les équipes médicales ; cependant, cette professionnalisation de certains patients rétablis ne va pas sans soulever quelques inquiétudes et questions éthiques, comme tout métier novateur. Objectives This article aims at explaining the concept and the process of recovery and identifying its different stages, as well as analysing which patient's and caregiver's behaviours will help this journey to recovery. The second objective is to demonstrate how professional peer support can be an innovative job that gives meaning to patients’ healthcare and participate to a paradigm shift in psychiatry, as this role redirects caring practices towards recovery, and not just the remission or healing of the disease. This paradigm shift is based on the assumption that patients can recover and transform themselves in a fulfilling life, despite a severe and chronic psychiatric disease, and that the person's wellbeing goes way beyond symptomatic remission. From this point of view, the patient needs to retake ownership of one's life and step out of one's “patient” status to take back all aspects of one's life: emotional, social, professional, personal, spiritual and civic. Various studies have proven that the job of professional peer support brings numerous advantages to fellow patients and medical teams, and that its appearance is but the legitimate consequence of a medical and sociological evolution during which treatment progresses have improved patients’ life quality and enabled them to take back ownership of their life and become more and more involved in the care pathway and within healthcare institutions. On the other hand, this professionalisation of recovered patients does generate some concern as well as ethical questions, as is only normal in any new and innovative job role. Methods Patient testimonials. Review of international publication. Conclusions Peer support professionals belong to the new players in mental healthcare. They enrich professional practices and healthcare offering. They bring hope since they are living witnesses of recovery, and contribute with their deep knowledge of this concept, its stages and the elements, behaviours and environments that foster its process. They enable the paradigm shift that would help people to step out of their patient status to become their true self, without being limited by the disease, but with the ability to live a chosen, satisfactory and fulfilling life. They could be the drivers to create new recovery-oriented programmes and practices, which are unfortunately much too rare today, and help catch up France's delay in this area. This is absolutely possible under the condition that peer support professionals get truly recognised for their role and find their true position as part of the healthcare community. [ABSTRACT FROM AUTHOR]

Much of what are understood as ‘mental health difficulties’ reflects shortcomings in the ability to develop and sustain healthy relationships. Many of those embarking upon life as someone with a psychiatric diagnosis are people whose difficulties can be traced to adolescence, or even earlier in life. Unsatisfactory relational experiences during childhood are acknowledged contributors to subsequent psychological vulnerability. Numerous studies identify associations between other forms of relational disturbance, and the onset and maintenance of psychological difficulties. Some eighty years’ psychotherapy research has repeatedly suggested that the quality of therapeutic relationship is a major determinant of outcome. Sophisticated analyses of large databases now confirm this beyond doubt. All concur that social exclusion and stigma are the most disabling consequences of living as someone with a psychiatric diagnosis. None of these facts are disputed but there is continuing resistance to broad acknowledgement of their implications. This has many parallels with other examples of paradigm shift, as so clearly outlined by Thomas Kuhn. Uncertainties about the value of medical psychiatry and growing recognition of the role relationships play in the genesis and relief of mental health difficulties suggest that psychiatry can be seen in similar terms. This paper develops that thesis. [ABSTRACT FROM PUBLISHER]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec 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.)