This article describes a research study completed on the process of empowerment. Conducted with 55 men and women who had experienced extensive powerlessness in their lives, qualitative interviews and focus groups were designed to understand participants' lived experiences as they struggled toward increased control in their lives. Several themes were identified, including elements which provided an impetus for empowerment and the importance of support from people. As the empowerment process unfolded, access to valued resources and participation in community life reduced isolation and contributed to the competence and confidence of participants. Several implications for the concept of empowerment are identified such as self-efficacy and personal control; and principles for community practice are outlined. This study confirms the importance of understanding empowerment from an ecological perspective.

The purpose of our study is to describe the major features of the articles published in the first decade of the Canadian Journal of Community Mental Health (CJCMH). We examined all 194 articles published in 1982 through 1991 with respect to seven dimensions: authors' gender, authors' affiliation, collaboration, article categories, levels of analysis, populations of interest, and the research relationship. Our findings suggest that: (a) CJCMH has provided increasingly more opportunities for female authors over the years; (b) authors have typically been affiliated with academic settings; (c) the majority of articles were written collaboratively; (d) a minority of articles pertain to empirical research; (e) most empirically based articles employed an individual level of analysis methodologically, while overall authors' interpretations primarily reflect multiple levels of analysis; (f) consumers/survivors represent the population most often investigated; and (g) CJCMH authors are not providing much useful information regarding the research relationship. We conclude that CJCMH authors, reviewers, and editors must continue to consider and incorporate the key values and concepts of community mental health when preparing and soliciting articles for publication.

The emergence of new adult guardianship and related legislation and systems in British Columbia, Ontario, and other jurisdictions has generated questions about the utility of separate mental health legislation. Mental health statutes are the descendents of legislation that once created and regulated separate institutions and systems for the insane (later known as the mentally diseased and, more recently, the mentally ill). Such legislation is no longer consistent with the dominant community care and treatment strategies in the mental health field and the growing trend to recognize and respect consumer involvement in care and treatment decision making. Emerging legislation in the guardianship field makes provision for a range of options and mechanisms that can replace separate mental health statutes (e.g., general consent to health care legislation, and provision for enduring powers of attorney of the person and Ulysses agreements) and produce a new and more effective legal framework for the provision of mental health care and treatment.

This paper explores the highly controversial issue of compulsory treatment of allegedly mentally disordered persons within the community. In light of American literature on the subject, we examine and contrast the positions and arguments of a variety of Ontario stakeholders. This is done through content analysis of 224 submissions to the Ontario Ministry of Health in response to its “Discussion Paper Towards Community Mental Health Services Legislation of January 1990” which addresses the specific question: “Should the legislation include provisions for out-patient commitment/compulsory community treatment?” Our purpose in this paper is not to determine the desirability or undesirability of compulsory community treatment (CCT) as such, but to examine Ontario positions as a first and necessary step in the process of acquiring perspective on the issue.

The present survey examines the barriers associated with the delivery of mental health services to the elderly as perceived by mental health professionals. The sample consisted of 139 professionals of the New Brunswick Mental Health Commission. The results reveal that the mean percentage of elderly clients in the practice of mental health professionals is low. The percentage of elderly clients in the practice of mental health professionals was positively correlated with training in gerontology. The attitudes of the respondents toward the elderly were either positive or neutral rather than negative. In addition, the results show that the barriers perceived by the professionals to explain the low utilization rates differ in order of importance from those acknowledged by the elderly. The lack of human resources was identified as the major barrier to the development of specific consultation services to the elderly. Finally, the implications of these results for the development of mental health consultation services for the elderly are examined.

This study examines various aspects of the mental health of aged caregiving spouses. Two factors are considered: the type of health problem of the care-receiving spouse (cognitive or physical impairments), and sex. Two samples of spouses providing care are examined: (a) those providing care to spouses suffering from cognitive impairments and (b) those providing care to spouses suffering from chronic obstructive pulmonary disease (COPD). These participants are compared to a group of non-caregiver aged spouses as well as other aged American normative samples. All participants completed the Brief Symptom Inventory developed by Derogatis and Spencer (1982). Results show that those providing care to their cognitively impaired spouses tend to be more mentally fragile than the caregivers of spouses suffering from COPD and the non-caregivers. The only difference found between men and women caregivers or men and women non-caregivers is related to interpersonal sensitivity. When compared to aged American normative samples, non-caregiver spouses showed less symptoms of obsessive-compulsiveness, anxiety, and hostility. Our study points to the importance of considering the type of health problem of the care receiver. It is also important to assess various aspects of mental health and to be able to use a measure of mental health which is specific to the aged population of Québec.

La consommation d'alcool et de drogues de 162 patients présentant une symptomatologie psychotique et n'ayant pas de diagnostic primaire d'abus ou de dépendance à une substance psycho-active, fut mesurée à l'aide d'une entrevue structurée. Dans ce groupe, la consommation régulière au cours de la vie atteignait 54,3% (intervalle de confiance, IC, 95%; 46,3% à 62,3%), tandis que 29,0% (1C 95% : 21,7% à 36,3%) se seraient mérités un diagnostic second d'abus de substance psycho-active à un moment ou à un autre de leur vie. Les informations provenant de l'entrevue structurée furent ensuite comparées à celles inscrites au dossier médical par le personnel soignant pour trois échantillons de 21 patients (grands consommateurs, consommateurs modérés, et abstinents), produisant un accord très faible (Kappa = ,128) entre ces deux sources d'information. Quoique, le personnel soignant interroge les patients sur leur consommation de substances psychoactives, il omet de rapporter la fréquence, la quantité, et la durée de celle-ci dans plus de la moitié des cas. Plusieurs cas connus d'abus de substance psycho-actives ne sont pas officiellement diagnostiqués, ni traités. La discussion fait ressortir différents facteurs possiblement responsables de cette situation.

Recognition of the crucial role of social adjustment in the assessment and understanding of major mental disorders is now well established. Deterioration of social relations is one of the criteria to diagnose schizophrenia according to the DSM-III-R. Recent findings (Bellack, Morrison, Wixted, & Mueser, 1990) suggest variable correlations between social adjustment and positive symptoms. This may indicate that the impairments in social functioning are not simply consequences of positive symptoms. Adequate assessment of social functioning is also needed to prescribe proper interventions and for planning purposes. This study was conducted in order to examine the psychometric properties of a modified version of the social adjustment scale (SAS-II). The French version of the SAS-II was modified to allow the assessment of social functioning in hospital settings and other supervised settings. Participants were 276 persons suffering from major mental disorders, mainly schizophrenia (57.4%). Respondents were selected in psychiatric hospitals, psychiatric units of general hospitals, and in the community. Five trained interviewers conducted interviews with the participants. Agreement between independent rates was strong, since 42 out of 45 items yielded intraclass correlations or kappa coefficients above .6. Testretest reliability was satisfactory. Alpha values ranged between ,47 and ,81, Validity was mainly assessed through discriminant analyses of the SAS-II scales with diagnostic groups and current program provision. Reliability and validity results confirmed the relevance of the modified version of the SAS-II for assessing individuals with severe psychiatric disorders in contact with psychiatric services. Recommendations for future development of the scale are proposed.

This paper reports the findings of an evaluation of supportive housing for people who have been hospitalized in psychiatric facilities. Both qualitative and quantitative methods were used to inquire into two key processes, social support and control in the residence, and two key outcomes, quality of life and personal growth. Interviews were conducted with 34 residents of small supportive housing programs, and staff of these settings also provided information. While residents were generally pleased with the amount of support and control they had in their residences, there were some areas in which staff exerted unilateral control (i.e., they made decisions without involving residents in the process). With respect to quality of life, residents were satisfied with their housing, but voiced some concerns over a lack of privacy, stigma, and limited opportunities for participation in the community. Residents reported showing personal growth since entering supportive housing in terms of greater independence, more instrumental role involvement, and improved self-esteem and social skills. Staff confirmed these changes. Residents indicated their increased feelings of competence were due to the social support of staff and friends, acceptance by members of their networks and the community at large, and participation in the residence and community activities. The findings expand our understanding of supportive housing in showing that such programs have beneficial effects besides reduced recidivism rates and increased work productivity for residents and in identifying program processes which contribute to residents' increased competence. Moreover, the findings illustrate the value of using qualitative data in program evaluation.

This paper reports an evaluation study of a pilot project held in a “CLSC” (Local Community Health Centre) located in a rural community. The intervention design is based on multidisciplinary teams created to meet specific local community needs. Mental health intervention is part of community-based approach open to all kinds of requests for support. Practitioners in the field give support not only to the individual with a mental health problem, but also to existing self-help networks in the community. The intervention is also designed to change the relationship between a professional, seen as the one who provides services, and a client, defined as a consumer. The term “client” gains a wider meaning, and collaborative work with informal self-help networks induces a closer relationship between the community and the practitioner. The practitioner is more open to local community values and adjusts his or her practice to match variable contexts. The evaluation study has expanded knowledge on this type of intervention design, on its impact upon service demand, intervention modalities, and service management and organization. This project was coupled with a similar project in an urban environment and was financed by the Health and Social Services Ministry in Québec.

Health promotion efforts have concentrated on promoting physical well-being with psychological benefits perhaps most often among men. With greater proportions of women now working, the workplace provides excellent opportunities for health promotion and education for women. Given increasing recognition that stress, multiple roles, and inadequate job rewards result in loss of productivity, absenteeism, illness, addiction, and premature death, it seems time to explore workplace programs of mental health promotion aimed specifically toward women workers. In this paper, current knowledge about the mental health problems experienced by working women is outlined. Some principles on which mental health promotion programs for women in the workplace might build are specified.

This paper reports on an evaluation of the Self-Help Clearinghouse of Metropolitan Toronto. The purpose of the Clearinghouse is to facilitate the growth and development of self-help/mutual aid groups, and to inform and educate both the Metropolitan Toronto professional helping community and the larger community of the nature and availability of self-help. This study included: (a) a pre- and post-test assessment of awareness, knowledge, and utilization of the Clearinghouse's services and (b) a descriptive assessment of the perceived value of the Clearinghouse from the perspective of a range of informants. Study information was collected from: (a) a selection of representatives of Metro Toronto self-help groups (pre-test N = 70 and post-test N = 52) and (b) a selection of representatives of Metro Toronto health and social services agencies (pre-test N = 70 and post-test N=55). The findings demonstrated that the awareness, knowledge, and utilization of the Clearinghouse's services by members of the self-help community and human service professionals increased over a 21/2-year period. Statistically significant differences were noted among both groups in terms of increased awareness and utilization of the Clearinghouse. As well, professionals' increased knowledge of information and referral services and the directory and the self-help groups' perception of a need for a unique organization dealing with self-help were statistically significant. Both groups perceived a need for a distinct clearinghouse for self-help groups and were very satisfied with the services of the Self-Help Clearinghouse in Metropolitan Toronto.

This review of parent education evaluations examined three approaches to parent education: behaviour modification, parent effectiveness training (PET), and the Adlerian approach. Our review demonstrated that on the majority of outcome measures, whether examining behaviour or attitude change or change in family dynamics, results were either mixed or not statistically significant. The most frequent methodological problems were lack of random assignment, failure to match groups, absence of consideration of experimenter bias, and failure to incorporate sufficiently large numbers of individuals into the design. There was also an absence of long-term follow-ups and control groups, whether a no-treatment or placebo group that was truly independent of the program. Finally these evaluations are limited in their ability to match outcome to process and to parent characteristics and thus hindered in their ability to plan effective parent education programs.