In this paper we describe a socio-ecological model of coping to serve as a conceptual framework for research on the factors influencing the quality of everyday life among the chronically mentally disabled in the community. Interview data collected from 66 clients in three aftercare programs in Hamilton. Ontario are used to construct composite indices of coping and satisfaction. The relationships between these indices and client and community variables are examined. The results are the basis for profiling the characteristics of clients who report different levels of coping and satisfaction.

This article describes the benefits of qualitative research in community needs assessment. The value of “going to the people” in order to understand the reality of consumers' lives is outlined. A recent qualitative study with individuals with chronic mental disabilities is used to illustrate the development of themes and patterns of needs. The themes include people's struggle for identity, need for support, and the dilemmas of hospitalization and lack of employment.

Deinstitutionalization has markedly decreased the physical and psychological distance between residential neighbourhoods and the chronically mentally disabled (CMD), who often rely extensively on community mental health facilities for necessary services. Few empirical studies of neighbourhood response have focused on different types of community mental health facilities, even fewer on facilities for the CMD. The present research compares the attitudes and behavioural intentions of neighbours toward community mental health facilities classified on two dimensions, namely (a) residential versus nonresidential and (b) serving primarily the CMD versus moderately disabled clients. The results indicate that neighbourhood attitudes and intentions toward facilities for the CMD do not differ significantly from those toward facilities for moderately disabled clients. In contrast, residential facilities were rated by opponents as having more negative, long-range impacts than nonresidential facilities and produced strongly polarized intended actions between supporters and opponents. Overall, most respondents rated facilities for the CMD as either desirable or neutral, even when on their block, and many would take supportive action if such a facility were proposed for their neighbourhood. Several qualifying conditions were identified which would increase support for community mental health facilities in residential neighbourhoods.

Beaucoup de personnes présentant des problèmes chroniques de santé mentale réintégrées à la communauté sont accueillies par leur famille. Par contre, l'obligation morale des parents face à leur proche ne doit pas obscurcir la responsabilité politique de développer des ressources de réadaptation pour allèger leur fardeau. Les parents ne peuvent composer avec cette situation problématique qu'au detriment de leur propre santé mentale et physique, Cette étude a pu déteriner que les parents portent un lourd fardeau et sont laissés à eux-memes pour composer avec cette situation difficite. Ils ont par contre acquis une série d'habiletés specifiques dans ce domaine et devraient ětre reconnus comme des interlocuteurs valables par les professionnels de la santé mentale dans le traitement et la réadaptation de leur proche.

This paper reviews research concerned with community housing programs for the chronically mentally disabled (CMD). In the first section, the ecological perspective is presented as a conceptual framework for the study of housing for the CMD. Several key concepts, such as the least restrictive environment, normalization, and integration, are tied into the ecological perspective. In the second section, literature on three dimensions of the social context of housing for the CMD is reviewed: (a) the geo-social environment: (b) responses from informal social systems; and (c) the planning, policy, and service delivery system. This literature is summarized within the framework of the ecological perspective, and the paper concludes with directions for further research and action.

This paper reviews process and outcome research on community housing programs for the chronically mentally disabled. Several methods for conceptualizing and assessing housing environments are presented, and pertinent literature on each method is then reviewed. Next, research on the impact of various types of housing programs on clients' adaptation is reviewed. Methodological problems in both the process and outcome research are highlighted, and directions for future research are suggested. It is concluded that future research requires an integration of the process and outcome findings and methods to ascertain how different program characteristics are related to different facets of adaptation for different client groups.

This paper outlines the development of the Supportive Housing Coalition of Metropolitan Toronto, an organization which co-ordinates the efforts of housing agencies, consumers, and treatment facilities in the provision of psychiatric residential programs. An assessment of the organization's impact to date on housing policy, municipal by-laws, program types, and housing stock is described. The organizational model utilized by the coalition is also examined in light of literature on the subject.

L'organisation des services de santé mentale pour les jeunes adultes psychotiques est un problème très important en santé publique. Le but de la présente étude était d'évaluer un programme de santé mentale offert à cette clientèle par un centre psychanalytique. Les effets du programme ont été mesurés au moyen de trois indicateurs: les séjours hospitaliers en psychiatric, la dose de neuroleptiques prescrite, et le type d'occupation. Les usagers du programme à l'étude ont été comparés à cux-mémes avant et après leur admission au programme, puis ils ont été comparés aux usagers d'un programme témoin offert par la clinique externe d'un centre hospitalier de courte durée. Les résultats ont montré que le programme à l'étude réduisait de fačon statistiquement significative les séjours hospitaliers; cependant, lorsque l'on tenait compte des journées de résidence au centre, on ne trouvait pas de changement significatif quant au temps passé dans la communauté. On a également observé, pour les sujets du programme à l'étude, une tendance à la diminution de la dose de neuroleptiques prescrite et une augmentation de la proportion des personnes qui occupaient un emploi rémunéré. D'autres indicateurs devraient étre étudiés afin d'évaluer plus précisément les avantages et les coúts de la mise sur pied d'un programme comme celui à l'étude par rapport aux programmes classiques offerts par les centres hospitaliers.

This paper describes a novel approach to the creation of a stable and responsive support system for the chronically mentally disabled living in the community. It begins with an explanation of the clinical relevance of social network and support analysis, and then concentrates on the goals and the methods of assessment and intervention that have been pursued by a team of occupational therapists who have been conducting social network therapy in Metropolitan Toronto. The article concludes with a discussion of the promise, obstacles, and limitations of this approach.

Cette recherche a pour but de dégager les principaux éléments de la “sociologie implicite” présente dans le discours d'intervenants “alternatifs” dans le champ de la santé/maladie mentale. Elle montre comment ceux-ci se définissent dans des rapports sociaux conflictuels en regard d'un modèle considéré comme dominant dans les institutions de santé: le modèle bio-médical. Cependant, cette base conflictuelle n'est pas pure contestation et s'appuie aussi sur l'affirmation d'une compétence et d'une vision propres à une pratique alternative en santé/maladie mentale. Les enjeux posés (le pouvoir des experts, le rapport personne-société, etc.) dépassent les seules pratiques dites “alternatives” et concernent l'ensemble de la pratique en santé/maladie mentale et la société.