Client's rights is an issue which resurfaces periodically in professional journals, but which is ever-present in the minds of consumers of mental-health facilities. While some of the most striking pleas for adherence to rights have centred in the past on inpatient mental-health facilities, similar issues related to client treatment continue to exist in community mental-health centres. This paper reviews the literature on outpatient clients' rights from the perspective of both clients and professionals. The paper provides suggestions for mental-health professionals to more adequately address the rights of their clients in terms of the workplace, the organization of their agencies, and through legal/legislated means.

Quatre projets d'appartements surveillés sont évalués sur une période de deux ans. La description de leur fonctionnement quotidien permel d'observer I'implantation de ces programmes communautaires et de mieux comprendre leur impact. Les données recucillies indiquent que plusieurs evenements difficiles se produisent au sein de ces ressources et que ces appartements surveillés représentent un milieu de vie stressant. Ces résultats peuvent en partie s'expliquer par les écarts observés entre la philosophie de base du programme et son implantation. Ces écarts concernent la durée de séjour au sein des appartements surveillés, les critiéres de sélection des résidents, le ratio bénéficiaire/animateur, les programmes de traitements et l'intégration de ces residences communautaires dans le réseau existant des services de santé et sociaux, Des recommandations concernant le fonctionnement clinique et administratif sont proposées.

This paper will review techniques for promoting the durability of interventions designed to address the return to the community of the chronically mentally disabled client. Specific practitioner techniques are identified, described, and evaluated both in terms of the authors' clinical practice and the research literature. the focus is on social-skills training in general, and in particular, job training, rehabilitation, and community adaptation. They argue that clinicians and researchers should focus on Generalization, Maintenance, and Transfer. This paper presents trainer guidelines and techniques, identifies promising developments, and points to evaluative gaps in our knowledge.

Recent research on community acceptance and rejection of persons believed to be present or former mental patients is reviewed, largely in a Canadian context. The evidence indicates generally that such persons appear to be accepted in some types of situations although the underlying image of the mentally ill has remained largely negative. In other types of situations, use of unobtrusive measures in research has shown that such persons face the likelihood of avoidance or rejection.

The past decade has seen an upsurge in the development of self-help groups encompassing mutual assistance and/or social advocacy dimensions. Although considerable analyses of the sociological functions of such groups have been conducted, the literature concerning psychological benefits and costs of membership, particularly in victim support groups which commonly combine these two dimensions, is sparse. The present article reports on a group therapy experience, where group participants were all active members of a self-help organization and had all lost family members in accidents involving drunk drivers. This experience highlighted the importance of a number of issues located at the intersection of social goals and individual needs, a grey area the authors believe will become a matter of increasing concern and challenge. Rising costs of health care and the search for alternate treatment models make these issues of special interest to those involved in community mental health. This article is addressed to clinicians and researchers, both of whom will be needed to bring greater understanding to issues emerging from the growth of victims' support groups.

Le développement communautaire dans la région des Bois-Francs illustre de fačon concréte la pratique de l'intervention communautaire. Ce type d'intervention se distingue de l'intervention sociale par une vision globale de la situation, la prise en charge individuelle et collective, et la mise sur pied d'organisations démocratiques pour répondre aux besoins. Elle est axée sur des valeurs alternatives et une recherche de justice sociale. L'article décrit les caractéristiques particuliéres du développement communautaire dans cette région et de l'intervention qui lui est propre, et identifie son impact tant au niveau social qu'économique. Il conclut en exposant les enjeux auxquels le mouvement communautaire se voit actuellement confronté.

Ninety-one Employee Assistance Program (EAP) policies were examined to assess factors associated with temporal changes and union endorsement. It was found that recent policies and policies with union participation were significantly more likely to: (a) emphasize mechanisms for promoting voluntary referral, (b) contain more procedures to protect confidentiality, and (c) mention the importance of informing employees about the EAP.

Cet article décrit la première année d'opération d'un programme d'aide par les pairs à l'école secondaire implanté simultanément dans deux quartiers de Montréal ainsi que la démarche d'évaluation qui a accompagné l'implantation du programme. L'objectif de l'évaluation était de documenter le processus d'implantation et les effets du programme en faisant ressortir les conditions favorables ou défavorables à sa réalisation. Les résultats montrent que les modalités d'implantation ont varié beaucoup d'un territoire à l'autre. Les jeunes ayant reču la formation ont démontré une amélioration significative de leur capacité d'empathie et de leur sentiment de compétence dans un seul des deux territoires. Bien que le programme ait connu une bonne notoriété auprès des élèves, peu de contacts d'aide ont été observés dans les deux territoires. La discussion porte sur le róle des caractéristiques culturelles des clientèles et des milieux visés dans l'implantation des programmes d'aide par les pairs.

Problems in estimating rates of suicide in North American Native populations are considered. Despite many problems of research, there does appear to be evidence that suicide rates are much higher in Native groups. An ecological method of calculating rates of suicide and careless death (including open and many accident verdicts) in males aged 15 to 34 is described. This method indicates that in Alberta Native reserves have substantially higher rates of suicide and careless death than adjacent rural areas. There is a south to north trend in these rates. Economic development (more common in the central and southern region of the province) is associated with lower death rates. It appears from these data that modernization and increased economic opportunities among Native communities is associated with decreased rates of suicide and of alcohol-related rates of careless death.

The present article is a critical account of the official report from the Commission of Inquiry on Health and Social Services in Quebec (la Commission Rochon). This report is first examined in light of the socio-political context of Quebec society in the '80s with a particular emphasis on factors which directly influenced the development of the Commission's work. The author then presents the main elements of the report. He stresses the quality and appropriateness of studies bearing on Quebec social evolution during the last 20 years and on the identification of health and social problems in the present time. He reminds us of the radical diagnosis made on the organization of health services. The principal options for more adequate health system orientations are then studied in the context of debates following the report publication, two years ago, particularly concerning issues of regional decentralization and financing. The author finally stresses the new challenges of today in social health management, while showing the profound continuity existing between the Commission's works and those of the Castonguay Commission, at the beginning of the '70s.

Staff attitudes are an important determinant of success or failure when implementing new technologies. Attitudes toward computers were generally very positive among 207 staff of a community mental-health service, but there was notable variation across professions. Attitudes were least positive among physicians and psychologists; social workers held more intermediate views; nursing, clerical, and other (administrative, rehabilitation, and support) staff held the most positive attitudes toward computers. Younger staff were more positively disposed to computers than staff older than 50 years, and attitudes were more positive among staff with higher levels of previous experience with computers.

This survey examined aspects of the support provided by 388 middle-aged respondents to their parents and parents-in-law independently residing in the same city. Burden was found to be relatively low (mean = 8.19 on a 33-point scale), and generally not associated with demographic characteristics of the care provider (sex, age, marital status, number of children, employment status, income, etc.). Higher burden was associated with provision of more support and lower emotional closeness to the parent. More help was provided to women and persons with higher dependency needs. When comparing the most and least burdened caregivers, frail and deteriorating health of the parent seemed to be the critical factor. The relationship between parent and most burdened children was neither as satisfying nor as open as for the least burdened children. Parents of those who were most burdened already were in receipt of more formal services than the parents of the least burdened. Given the relatively low burden reported by the middle-aged offspring, formal programs were not instituted by the social-service agency. However, agencies responsible for providing formal care to the elderly might query the nature of the relationships between their clients and offspring, seeking particular sources of stress and burden which might be alleviated.

Many acute-care hospital beds are increasingly being occupied by chronically ill older persons. The hospital health-care team must begin to view the family of elderly patient along with their community contacts as an important resource in the delivery of services. A questionnaire was mailed to 27 adult children to determine the type of help they provide to their hospitalized chronically ill elderly parents. The results indicate that adult children are a major resource for the older person. Despite the formal caregiving structures of the hospital the adult child provides the most amount of help in the areas of psychological support, personal care, and bureaucratic mediation services. Not only do adult children provide help to the parent inside the hopsital, but through tasks carried out on behalf of the parent outside of the hospital they are able to maintain the elderly parent's link to their community network. This involvement offers many therapeutic opportunities for professional staff to link hospital resources with the resources of the community-based family.