Le paradigme du rétablissement en santé mentale remet la question de l'inclusion sociale, de l'appropriation du pouvoir d'agir et de l'espoir d'un mieux-être au cœur des approches d'intervention et des services. Dans le présent article, nous présentons les résultats du volet qualitatif (n = 15 participants et participantes) d'une recherche exploratoire réalisée à Québec auprès de personnes aux prises avec la schizophrénie ou des psychoses apparentées, vivant dans la communauté et suivies dans le cadre d'un programme de traitement et de réadaptation fondé sur une approche de rétablissement. Nos résultats fournissent un éclairage particulier sur les dynamiques de reconstruction et de rééquilibrage des liens sociaux dans les cheminements de rétablissement de ces personnes. Ils suggèrent ainsi que la relation entre l'inclusion sociale et l'appropriation du pouvoir d'agir est dialectique: l'inclusion sociale est facilitée par, et contribue à, l'appropriation du pouvoir. De plus, cette dialectique se vit aussi dans un changement du regard porté sur soi et sur son devenir, incluant l'espoir d'être « mieux », d'être « plus » et, surtout, d'être avec.

Plusieurs équipes de première ligne en santé mentale ont été implantées au Québec. Ces équipes se développent en l'absence de modèles bien définis. Une étude de cas, inspirée d'une approche constructiviste, visait à soutenir l'une de ces équipes dans un processus d'énonciation et de consolidation de son modèle d'intervention. Deux groupes, l'équipe (n = 16) et ses partenaires (n = 42), ont participé à l'étude. Bien qu'un modèle d'intervention ait été énoncé, celui-ci apparaît peu explicite. Préciser un modèle novateur d'intervention pour l'équipe de première ligne en santé mentale est apparu d'une complexité quasi inextricable, dont la meilleure issue s'est trouvée dans la réaffirmation d'un énoncé général orientant vaguement l'intervention.

Scales initially developed to measure coercion in inpatient psychiatric settings were adapted to the assertive community treatment (ACT) team setting and administered to consenting clients of a high-fidelity team in Montreal (38/68). More than 75% of respondents scored 5 out of 6 or above on the client-centredness scale. The remaining respondents, who scored below 5, also tended to report more negative pressures (threat or constraint) and more perceived coercion, and they tended to be lower functioning and to have personality disorders. A simple measure of client-centredness could help ACT teams identify clients who might benefit from a different clinical approach.

Mental health services in western English-speaking countries are struggling to respond to growing cultural and racial diversity. The overall purpose of the Community University Research Alliance (CURA) study was to explore, develop, pilot, and evaluate how best to provide community-based mental health supports that are effective for people from culturally diverse backgrounds. Using a participatory action research approach within a multimethod design, the study partnership has developed an emerging framework that synthesizes the ideals of previous culture-oriented and power-oriented models. The emerging framework has 3 main components: values that guide concrete actions that in turn produce desired outcomes. Central to the emerging framework is the need for reciprocal collaboration between the mental health system and cultural-linguistic communities.

The shift from hospital-based care to community-based programs for people with serious and persistent mental illnesses has led to the creation of numerous treatment programs, including the recent implementation of community treatment orders (CTOs). This form of mandated outpatient commitment is controversial because it is widely acknowledged to be a coercive intervention. Yet, there is little discussion about why this intervention is considered coercive and whether coercion is acceptable in the context of emerging commitments to recovery for people with serious and persistent mental illnesses. Moreover, there is a need to evaluate whether CTOs advance or undermine the interests of people who are diagnosed with mental illness. This paper seeks to contribute to a discussion of these issues by exploring coercion and its role in community mental health care, and how it may co-exist with recovery in the implementation of community treatment orders.

This paper describes an ethnographic study exploring the employment of consumer-survivors at 2 Ontario community mental health organizations. The methodology included interviews with agency staff, participant observation, and document analysis to examine the natural environment of the employees at the 2 organizations and the ways in which the organizations supported the employment of consumer-survivors. The themes identified uncover some of the strategies these organizations use to support consumer-survivor employees: (a) create the context for consumer-survivor employment, (b) encourage autonomy, (c) provide a supportive atmosphere, and (d) set up consumer-survivors for success. These themes lead to specific recommendations related to hiring processes, working conditions, and attitudes.

With the aim of uncovering contributors to research-practice gaps in child mental health programming, this study sought to identify factors influencing the adoption of parenting interventions by community agencies. This qualitative case study with embedded units uncovered 3 key factors: resource demands of interventions, the fit of interventions with agency mandates, and the perceived needs of target populations. Autonomy of decision-makers within agencies was evident although curtailed by resource limitations. Although research evidence is valued, it does not appear to play a central role within the adoption process. How these factors may contribute to research-practice gaps is discussed.

Though several instruments have been developed for measuring work values in the general population, at present no instrument has been validated for people with mental disorders seeking a job. Employment specialists could use such a questionnaire to help people with severe mental disorders to get competitive employment, and consequently to maintain employment, as a pitfall for this population is job tenure. The Questionnaire de Valeurs de Travail (QVT), translated into English as the Work Values Questionnaire (WVQ), measures five work values: climate, status, risk, realization, and freedom. Our study's objectives were (a) to validate the QVT in individuals with mental disorders seeking a job; (b) to create a short version of the QVT; (c) to classify people on the basis of their work-value patterns, and (d) to compare these profiles on the basis of work outcomes and related personal characteristics. Individuals with severe mental disorders (N = 254) registered in vocational programs filled in the QVT. The confirmatory factor analysis showed reasonable fit indices for the 58-item QVT and good fit indices for the 30-item QVT shortened form. People who placed a higher importance on work values were employed more often in competitive employment.

Improving the continuity of care for suicidal persons is an important challenge in suicide prevention. However, partnerships between hospitals and community-based services are difficult to create and sustain. The aim of this study was to explore the point of view of health care professionals from a range of disciplines and organizations concerning the factors that facilitate or hinder interagency collaboration in enhancing continuity of care for suicidal persons. Structured interviews were created from a purposive sample of 40 professionals recruited from 15 partner organizations in mental health services. Results indicated that interagency trust is essential to improved continuity of care, and that building trust requires time and sustained contacts. Regular meetings allowed partners to discuss and collectively solve problems. Barriers included staff turnover, difficulty in evaluating the severity of suicidal crisis, and the time required to exchange information.