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Goal: Quebec's three mental health university institutes (DMHUI, IUSMM and the IUSMQ) and the Centre hospitalier universitaire de Sherbrooke submitted a statement to the provincial consultation forum on the 2014-2020 Mental Health Action Plan (MHAP), which was held in January 2014 and organized by the Ministère de la Santé et des Services sociaux (MSSS). This article presents these institutes' main recommendations., Method: Mental health university institutes deliver a wide and diverse range of services. They know about the challenges of organizing mental health services and are aware of national and international trends in the delivery of the best organizational and clinical practices in mental health. It is therefore as key stakeholders in the mental health care network that they commented on each component in the working paper., Results: The proposed orientations are consistent with the 2005-2010 MHAP. The presented themes clearly reflect current issues, although the guidelines must be more explicit regarding the vision of how services will be organized in coming years. These institutes therefore suggest that the following principles be included: the full exercise of citizenship rights, the organization of services within integrated networks, performance, continuous improvement and innovation, as well as a global and integrated vision of health. The complexity of today's problems requires flexibility, complementarity and continuity of services, particularly for youth, aboriginals, and people with concomitant disorders. These institutions therefore stress the importance of prevention, early intervention programs, and increased support for first-line general practitioners and health care professionals. They also emphasized that specialized inpatient and outpatient services should not be neglected. Community services must also be structured around various levels of support, such as ICM and ACT, as well as around specialized programs available in hospital outpatient clinics. The development and transfer of knowledge remain a central issue when it comes to improving the mental health of the general population. The consolidation of ultra-specialized services, teaching and research should be included in the next MHAP. Finally, a global health perspective must go beyond the MSSS framework to become a governmental and interministerial commitment based on a vision of public mental health that incorporates the health status of the general population and accounts for social determinants., Conclusion: It is important to have a national plan that promotes a vision. This plan must be part of an interministerial action plan that truly supports the full exercise of citizenship rights and the fight against stigmatization in collaboration with people who use these services and their families.

Objectives Exposure to repeated traumatic events during childhood and adolescence is associated with high prevalences of mental illness, addictions, physical health conditions, and psychosocial difficulties (Felitti et al., 2019). The most common consequence of exposure to trauma is violence towards self and others (Hughes et al., 2017). The very high prevalence of complex trauma among forensic mental health service users challenges these settings to modify their practices, training approaches, policies, and service delivery approaches. The objective of this article is to contribute to such a transformation of forensic mental health services by clarifying the impacts of complex trauma on the trajectories and experiences of forensic mental health services users, as well as practices responding to complex trauma. Methods We reviewed the published and grey literature on complex trauma among forensic mental health service users. After synthesizing the findings, they were contrasted with our experiences as clinicians and researchers in the field of forensic mental health care through the development of a case vignette. Results We first identify the role of complex trauma and victimization in the development and maintenance of violent behaviours. We describe the negative experiences of services and care settings reported by individuals with complex trauma in the absence of recognition and understanding of traumatic experiences and their impacts. We highlight the fundamental principles of trauma-informed care (trust and transparency; safety; peer support; collaboration and reciprocity; empowerment and choice; sensitivity to gender, cultural and historical differences), as well as the clinical and organizational approaches emerging from those principles. Next, we describe the approaches developed internationally to apply and implement trauma-informed care in forensic mental health setting, and the opportunities and challenges associated with their implementation in the Québec context. Conclusion To date, few studies have documented and evaluated the implementation of trauma-informed care in forensic mental health settings. The literature reviewed in this paper indicates that an in-depth understanding of complex trauma among forensic mental health service users should be at the core of contemporary forensic research, policies and practices.

Objective The objective of this paper is to provide an overview of the provision and organization of forensic mental health services around the world. In particular, we attempt to address the following question: What system-level characteristics are important to consider in relation to the organization and structure of forensic mental health services? Methods To do so, we synthesize publicly accessible information, identified through Academic Search Complete (EBSCO), ProQuest Central, Scopus, PsycInfo, Google Scholar and Google, to describe how forensic systems are organized throughout the world. We examine the fundamental principles in the organization of services and examine potential quality indicators. Results This review is a steppingstone for the identification of best practices. Based on these fundamental principles, an efficient forensic mental health system would include the following elements: providing a comprehensive and balanced continuum of services; integrating services within and between systems; matching services to individual need; adhering to human rights; responding to population diversity; and using the best available evidence to make system-wide improvements. Conclusion Though all of these system-level principles are important, we focus on how the first three (service continuum, system integration, and service matching) may be applied to the organization of forensic mental health services.

Along other breakthroughs in computer sciences, such as artificial intelligence, virtual characters (i.e. digitally represented characters featuring a human appearance or not) are foreseen as potential providers of mental healthcare services. However, their current use in clinical practice is marginal and limited to an assistive role to help clinicians in their practices. Safety and efficiency concerns, as well as a general lack of knowledge and experience, may explain this discrepancy between the expected (sometimes futuristic) and current use of virtual characters. An overview of recent evidence would help pinpoint the main concerns and challenges pertaining to their use in mental healthcare. Objective This paper aims to inform relevant actors, including clinicians, on the potential of virtual characters in mental healthcare practices and to raise awareness on societal challenges regarding their use. Method A narrative literature review was conducted to summarize basic and clinical research findings, and to outline an in-depth discussion on various societal caveats related to the inclusion of virtual characters. Results Basic studies highlight several characteristics of the virtual characters that seem to influence patient-clinician interactions. These characteristics can be classified into two categories: perceptual (e.g. realism) and social features (i.e. attribution of social categories such as gender). To this day, many interventions and/or assessments using virtual characters have shown various levels of efficiency in mental health, and certain elements of a therapeutic relationship (e.g. alliance and empathy) may even be triggered during an interaction with a virtual character. To develop and increase the use of virtual characters, numerous socioeconomic and ethical issues must be examined. Although the accessibility and the availability of virtual characters are an undeniable advantage for their use in mental healthcare, some inequities about their application remain. In addition, the accumulation of biometric data (e.g. heart rate) could provide valuable information to clinicians and could help develop autonomous virtual characters, which raises concerns over issues of security and privacy. This paper proposes some recommendations to avoid such undesirable outcomes. Conclusion Due to their promising features, the inclusion of virtual characters will no doubt be increasingly prevalent in mental healthcare services. All involved actors should thus be informed about specific challenges raised by such breakthroughs. They should also actively participate in discussions regarding the development of virtual characters in order to adopt unified recommendations for their safe and ethical use in mental healthcare.

Introduction Public Service Interpreting (PSI) is gradually becoming part of Quebec society. The institutional and organizational mechanisms designed to provide a framework for this interpretative practice are not yet generalized to all public services in the province, and where they are, many challenges remain. Objective The objective of the study was to provide stakeholders working in the mental health sector with practical strategies to foster collaboration with public service interpreters. Methodology A critical reading of the literature (narrative review) was carried out with the objective of offering a new perspective on the already existing object of study. Because it offers a critical synthesis of key information in the field, this method is particularly well suited to the needs of the reader who is not up to date with advances in the field. Results This critical reading first made it possible to identify two general challenges concerning mental health practitioners called upon to collaborate with public service interpreters: the recognition of the interpreter's role and the acknowledgement of the diversity of communicative situations likely to foster their collaboration. This paper presents seven interprofessional collaboration strategies that mental health practitioners can apply to meet these challenges: 1) using vocabulary drawn from the public service interpreter Positioning and Postures Typologies; 2) obtaining information to be transmitted in the interpreting assignment; 3) allocating time for briefings and 4) for debriefings; 5) encouraging the interpreter's presentation; 6) framing small and big talk; and 7) promoting the continuity of care. Discussion The present study offers a new perspective on some of the distinctive tensions in the PSI domain. The 7 proposed collaboration strategies are a response to these and aim to improve the quality of intercultural communication and services offered to users by promoting knowledge transfer. They are specifically addressed to knowledge users, take their practices into account and are explained using non-specific terms.

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Objectives: Recovery is a process through which people experiencing mental illness learn to live with their disorder and reach social insertion and citizenship. This positive approach focuses on a person's competencies and strengths rather than on the symptoms. Within this philosophy, peer support has been unevenly developing in mental health services worldwide with roots in the South-American social programs for homeless people and in the American recovery circles in the field of addiction. Therapeutic efficiency of peer support has been proven by several studies including a control group, as being at least as good as traditional services and even better in some specific areas such as reduction of need for emergency services and ability to reach "difficult" patients. The integration of former psychiatric services users in mental health services can take several forms, from the participation to scientific research studies to the direct involvement in a professional team at mental health facilities. In this context, our research aims to sum up the situation in France in comparison with other countries., Methods: We conducted a worldwide literature review in English and in French on peer support experiences and policies in mental health services, using medical and psychological databases (PsycInfo, PsycArticles, SantéPsy, Cairn, Medline, Wiley Interscience and PubPsych) on a recent period: 2005-2016. In total, 32 relevant scientific papers have been included in our research. In some cases, we have also used official reports, blogs, Internet sites, and mass media articles when they were relevant., Results: Our results show that this movement has been long to develop in France, with controversies having been raised since the beginning on the role that peers should play and confusion with existing social integration programs in the associative sector. Drawing inspiration from the Canadian model, a recent "peer mentor" initiative has been analyzed after 2 years of existence: many benefits for services users such as the optional aspect of this care process, a more authentic therapeutic relationship, a less normative frame, an active partnership, and a more optimistic philosophy aiming to make "small steps" towards improvement have been reported. Health professionals and peer mentors themselves have found benefits during the process. However, several limits such as difficulties to find a place with regards to the psychiatric team and difficulties to take advantage of the peer specificity, resulting in a significant attrition of the number of peer mentors, could be observed. A few other important initiatives focused on social insertion and using the help of professional peer support have been developed in recent years, but they seem to have encountered the same issues about positioning themselves both in terms of day-to-day integration in the professional environment and in the job title given by institutions which rarely corresponds to their experience and specificity. In addition, it remains difficult to obtain reliable information, as only a few papers have been published on this matter. Also, while some evaluation studies are currently being carried out, independent quantitative studies of the few running programs seem to lack in this field., Conclusions: In our presentation, taking into account the difficulties that were raised in French programs and the lessons of practical experiences at work in other countries, we propose recommendations for larger and more effective implementations of peer support programs in France. As this new kind of care is emerging and seems promising in terms of benefits for not only the users but also the peer supporters and the teams of health professionals, we also insist on the need for a systematic scientific and objective evaluation of the programs., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Suicide is a major public health issue in Canada. The quality of health care services, in addition to other individual and population factors, has been shown to affect suicide rates. In publicly managed care systems, such as systems in Canada and the United Kingdom, the quality of health care is manifested at the individual, program and system levels. Suicide audits are used to assess health care services in relation to the deaths by suicide at individual level and when aggregated at the program and system levels. Large health administrative databases comprise another data source used to inform population-based decisions at the system, program and individual levels regarding mental health services that may affect the risk of suicide. This status report paper describes a project we are conducting at the Institut national de santé publique du Québec (INSPQ) with the Quebec Integrated Chronic Disease Surveillance System (QICDSS) in collaboration with colleagues from Wales (United Kingdom) and the Norwegian Institute of Public Health. This study describes the development of quality of care indicators at three levels and the corresponding statistical analysis strategies designed. We propose 13 quality of care indicators, including system-level and several population-level determinants, primary care treatment, specialist care, the balance between care sectors, emergency room utilization, and mental health and addiction budgets, that may be drawn from a chronic disease surveillance system., Competing Interests: The authors have no conflicts of interest to disclose.

This paper presents and discusses the results of an intervention research conducted in Ouro Preto, Brazil from August 2014 to March 2016. The main objective was to contribute to the development of an intersectoral and interdisciplinary network to face psychosocial vulnerabilities of children and teenagers, especially related to sexual violence and drug use. To achieve this, we identified the difficulties faced by the Sistema de Garantia de Direitos Humanos da Criança e do Adolescente (SGDHCA) implemented by the municipality which take care of this population. We also identified protective and promotion factors accomplished to empower them. The methodology used combines Deleuze and Guattari Cartography, Institutional Analysis and the Cross Training. This latter methodology was developed by a group of researchers of Douglas Institute, in Montreal, which we met through scientific co-operation with our laboratory. On account of the practical-theoric and co-participative activities with the professional network of Ouro Preto, we produced a detailed diagnosis of the SGDHCA and a document proposing short, medium and long-term strategies. As final result, we intend to help the local collective-the Forum Intersetorial da Infância e Juventude-to develop a work plan from the proposed actions. In this paper we will concentrate the potential of the methodology used by presenting outcome from two important moments of the research: the discussions of successful and unsuccessful cases that elucidate the network operation and the potential and difficulties arising from the Rotation Positional, important technical of the Cross Training.

Objectives The aim of this paper is to revisit the Global Model of Public Mental Health (GMPMH) in light of the 4th Civic Forum. Recovery mentors of the University of Recovery chaired this public event, which was held in East-end Montreal, Canada, in 2016. The University of Recovery is a concept of co-learning among its members.Methods Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in public health and health promotion programs, while adding to that approach the recovery mentors, as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented practices through the Ottawa Charter for Health Promotion of the World Health Organization. Indeed, here the GMPMH is said to be global in that the supranational and individual levels reinforce each other, taking turns with a) a set of legal rules and international conventions on human rights, including those of disabled persons, and b) the active involvement and agency of recovery mentors who can evoke these rules and conventions as part of a plea for the recognition of their personal and collective capacity for change; they acted as tracers of recovery trajectories during the Civic Forum. The GMPMH was first published in 2009, and revisited in 2013. While this latter revision was based on the 3rd Civic Forum, in this paper we use the same approach to revisit the GMPMH as underpinned by the findings and recommendations of the 4th Civic Forum, which discussed questions related to work and employment.Results Updating the GMPMH in light of the Civic Forum underlines the need for a more inclusive type of governance regarding policy and systems transformation. Local communities and persons in recovery can reach each other to promote change and capacity building, for instance through quality assessment, and evaluation of human rights' level of respect in healthcare facilities and more broadly. People with mental health challenges ought to be "included in the community" - as this is a right, not a reward (UN Convention on the Rights of Persons with Disabilities, art. 19). This is achievable if the community is informed and welcoming, for instance in getting involved with a Civic Forum and its organizing committee. The degree to which a transformational agenda is participatory is revealed as a predictor of the degree to which the broader community can be reflexive about its own inclusiveness for a genuinely global approach of public mental health, and with a cascading emulation effect.Conclusion Transition from social marginalization to full citizenship represents a daunting challenge in public mental healthcare. Creating access to the valued roles which individuals will be able to occupy in community and workplace settings requires capacity building and inter-sectorial synchronicity, as suggested by recovery mentors who can act as tracers to reveal obstacles and gateways in the recovery journey. Public intervention and debate are required to promote and monitor the bond of citizenship that connects people to their communities, and the quality of this bond needs to be included in the scope of public mental health for continuity and equity of access.

In the early 1950s, both the publication of the first Diagnostic and Statistical Manual (DSM-I) and the advent of psychopharmacology - particularly the development of chlorpromazine (Thorazine - RP4650) - set the stage for models of psychiatric thought, research and practice that remain dominant today. It was during this pivotal period, in 1955, that the Département de psychiatrie de l'Université de Montréal was founded by a cohort of young researchers newly arrived from well-known universities in France and the northeastern United States. This influential group quickly became staunch critics of the province's religion-based asylum system and lobbied for a government review that culminated into the 1962 Commission d'étude des hôpitaux psychiatriques (popularly known as the Bédard Report). What followed in Quebec between 1965 and 1975 was the secularization of psychiatric institutions and widespread deinstitutionalization. This paper illuminates cultural changes and intellectual shifts that have been overlooked in historical studies of post-war psychiatry by exploring the expansion of such "anti-psychiatry" schools of thought in Quebec in this period.

Objective: In terms of health and social services, the territory of the province of Quebec is covered by four large 'integrated university health networks,' which are involved in the coordination of care delivery and medical training. The francophone components of the public mental health system for Montreal are thus primarily linked to the Integrated University Health Network of University of Montreal. In 2010, the Faculty of Medicine of the University of Montreal has included in its development strategy a firm commitment to the development and implementation of the 'patient partner expertise' in research, training and care in order to make this expertise no less than the brand of the Faculty. This commitment applies to all medical specialties that are taught at University of Montreal, including in psychiatry. More recently, the Institut universitaire en santé mentale de Montréal (IUSMM) has endorsed a new clinical vision that promotes full citizenship, which implies that service users and carers are considered as full partners with a specific expertise to be fully deployed. The objective of this paper is to examine, from an ethical point of view, the challenges that may be associated with involving such lay persons in various levels of mental health care planning and delivery, and in research., Methods: This study is mainly based on a review of the institutional processes that are in place at the IUSMM to promote service users' participation in care planning and delivery, and in research. The focus is on the practicalities and conditions for the exercise of such an active participation, as some questions and concerns emerged through a series of interviews with different stakeholders. These issues are addressed and discussed through the lenses of the ethical values that were formalized at IUSMM., Results: Despite a firm institutional commitment at IUSMM to implement its new citizenship-oriented clinical vision through greater service users' involvement, little is known about the possible negative impacts of their participation, on themselves and for regular employees. There is a consensus on the symbolic value of recognizing the potential of service users as contributors, as a peer workers or peer research assistants. This is an historic advance compared to a time when they were considered only as more or less passive recipients of services or as a simple research subjects. Some risk factors were nonetheless identified: isolation, emotional fatigue, possible relapse, insecurity, sometimes tensed relations with health or research professionals and misunderstanding. In organizational terms, among the pitfalls, the study highlighted the need for more cautious preparatory steps, guidance and support for service users and for professionals as well, and the importance of a global and integrated governance strategy., Conclusion: This study points to three main recommendations to better anticipate and manage possible risks associated with more or less improvised service users' active participation, as lay persons, in complex planning and service delivery and in research. The first would be directed towards professionals for them to reflect on the quality of the doctor-patient relationship in their facility as to see how service users can help to improve this relationship, but among a variety of stakeholders and without being the sole responsible for such an improvement, or for the lack of improvement thereof. The second recommendation would propose to draw an objective evaluative assessment of participatory approaches at the organizational level, promoting a real return of experience and in light of the issues raised by these practices. The third would recommend an update of the organizational ethical values when introducing practices that change the current paradigms of the provision of care and services and of research.

The importance of children and youth mental health is increasingly recognized. This rapidly developing field cannot be conceptualized as an extension of adult services to a younger age group and its developmental and organizational specificities are the object of debate. Reviewing recent literature in this domain and some preliminary information about the Quebec Mental Health Plan implementation, this paper addresses some of the questions which structure this debate in Quebec.Quebec mental health plan has put at the forefront collaboration among disciplines and partnership among institutions. In spite of having produced significant improvement in the field, discontinuities in services, which interfere with an ecosystemic model of care, persist. Recent studies suggest that the organisational climate which surrounds youth mental health services has a direct impact on the quality of services and on youth health outcomes. A flexible management structure, which engages clinicians and health workers, favors empowerment, minimizes work stress and facilitates partnership, is needed to foster successful interdisciplinary and intersectorial collaboration. This collaboration is the cornerstone of youth mental health services.

Purpose. This paper aims to summarize the current situation regarding the role of families of persons with mental disorders within the mental health system in Quebec.Methods. We made a research in the most recent and pertinent papers or books regarding: 1) the history of the family involvement in the mental health system in Quebec; 2) the present situation of these families and the models that we can see and 3) identify in recent governmental or research documents recommendations regarding a greater empowerment of the families in the mental health system.Results. The research provides a historical perspective to the roles occupied by families. First the family was described as a causal agent; the work of the psychoanalyst Freud described the family unit as a source of conflicts in the areas of affect and sexual dynamics, and which results in the appearance of psychiatric symptoms. Later, this view of a causal agent came both from the point of view of genetic and from expressed emotions. In the 70's new perspectives such as general systems theory (von Bertalanffy, 1968), described the family as responsive to mental disorder of one of its members rather than a responsible agent. With the deinstitutionalization movement, the family was perceived as a source of solutions for persons with mental illness, but also as persons who can live some burden. This subject became well described and a several studies reported about adverse effects of caring for a person with mental disorder on the health, well-being and feeling of caregiver burden. In the 90's, some government action plans called for the relationship between the family and the health system as a partnership. Also, families want to be involved in decisions about care and to be informed about the diagnosis and treatment options. ( Lefley et Wasow, 1993)A new model developed by FFAPAMM that identifies three main roles enables to contextualize the current role in the current system. This model, called CAP lists and describes three roles of families that, if they are dependent on the past, continue to mingle in our time. These roles are:Accompanist: the role imposed by being near a person with mental illness (Fradet, 2012). As an accompanist, the family needs to establish relationships with health professionals. Accompanists want to be considered by stakeholders and be respected in their desire to share information and participate in decisions.Client: this is the role that derives from the accompanist when the caregiver receives care services for its psychological or physical problems related to the fact support a sick person.Partner: it is relative to the involvement (or not) the role of family members in the organization of care. It is a role of participation and decision-making. In this context, we also speak of participation in the consultation mechanisms.Recommendations from a Quebec research project and a report of the Commission on Mental Health of Canada will consider a future where the needs and aspirations of families will be taken into account in mental health general services, short term health care, community mental health services. There are also some guidelines regarding education for professionals about the needs of families and about changing politics.Conclusion. There exists in all associations of families of person with mental disorders, training on topics such as how to behave towards different mental disorders or aggressiveness near reached. A project of the Douglas Institute has hired a family member to the emergency room to help families better manage this often difficult time and to facilitate communication with stakeholders. Another project called "Learning to come closer without aggression" has helped more than 200 family members undergo training inspired by the Omega approach, which helps them better manage their own behavior in situations of aggression with their loved one.

The Mental Health Action Plan maps out the reorganization of mental health services in the province of Quebec. Accordingly, this paper presents the transformation process of the mental health program at the Maisonneuve-Rosemont hospital in Montreal. The authors discuss, on the one hand, the challenges that were met and, on the other hand, the model of care and organisational choices that were adopted. This article is divided in three parts. The first part describes the two main guiding principles underlying the Mental Health Action Plan. The second part examines the context surrounding the arrival of the Action Plan at the Maisonneuve-Rosemont Hospital. The third part describes the hospital transformation process that evolved in relation with: 1- the new centralized access points for mental health services; 2- the support for first line (or primary care) services; 3- the second line services for the specialized treatment of complex mental health problems.

Because of its sector-based organization and extra-hospital care, public psychiatry has a unique position in healthcare. This paper describes the tools and procedures used to analyze and allocate the resources of the "Centre Hospitalier Alpes-Isère", a hospital serving a catchment population of 530,000 adults. A consensus-based approach was used to validate the selected indicators and included the participation of a geographer. Five levels of resource allocation were identified and classified using a decision tree. At each level, the relevant authorities and criteria were identified as key components of the decision-making process. This paper describes the first three levels of care provision. Focusing on adult care, a comparative assessment of the resources allocated to general psychiatric care and specialist care was conducted, in addition to a comparative assessment of the resources allocated to each of the hospital's four local centers. Geographical accessibility to extramural facilities was also assessed. A study of the characteristics of each general psychiatry clinic revealed significant disparities. The paper highlights several issues: the poor knowledge of psychiatric epidemiological data relating to the population within the catchment area, the difficulty of assessing non-consolidated data or indicators from multiple sources, and the limited and partial nature of geographical data for characterizing and evaluating health care in the hospital's peripheral clinics. Several studies are currently underway to assess the operational effectiveness of the tools and procedures used to analyze and allocate resources.

The level of cooperation between legal and healthcare professionals in psychiatry has increased significantly as a result of the greater emphasis on safety and security and the increasing tendency to place mental disorders in a judicial or legal context. As a result of the many new laws that have been passed since 1998, psychiatrists are increasingly required "to treat criminal recidivism and prevent violent behavior". These issues have been highlighted by the scientific, medical and legal community, though without ever resulting in any action by the public authorities. Based on an examination of the care provided to a prisoner before, during and after incarceration, this study suggests that despite the existing regulatory framework and the abundance of data on the provision of care (including psychiatric care), a comprehensive review of the current system is required. To what extent is care management effective and consistent? Are the stated economic objectives achievable? This paper argues that in a prison context the range of healthcare options needs to be clearly defined and laid out in order to provide mental health patients and mental health professionals with a realistic vision of care provision.

This paper reviews and summarizes the available literature on Haitian mental health and mental health services. This review was conducted in light of the Haitian earthquake in January 2010. We searched Medline, Google Scholar and other available databases to gather scholarly literature relevant to mental health in Haiti. This was supplemented by consultation of key books and grey literature relevant to Haiti. The first part of the review describes historical, economic, sociological and anthropological factors essential to a basic understanding of Haiti and its people. This includes discussion of demography, family structure, Haitian economics and religion. The second part of the review focuses on mental health and mental health services. This includes a review of factors such as basic epidemiology of mental illness, common beliefs about mental illness, explanatory models, idioms of distress, help-seeking behavior, configuration of mental health services and the relationship between religion and mental health.

The prevalence of psychiatric disorders and symptoms in nursing homes is high. This phenomenon could potentially harm the residents' quality of life but also complicate their treatment. To offer a regular psychiatric input, a group of psychiatrists and nurses specialized in psychogeriatrics have set up a consultation-liaison service in 14 nursing homes in the canton of Fribourg. In this paper, we report the results of a satisfaction inquiry realized after one year of collaboration. Dementia and depression were the two most common psychiatric diagnoses, accounting for more than two thirds of the cases. These services were found to be very satisfying, especially their educational dimension for the nursing home staff.

This paper aims at investigating causes and potential remedies of increased psychiatric hospitalization in this country. The data suggest that there was growing pressure on psychiatric hospitals from 1950 to 2000. This may result from inappropriate management of a new type of acute psychiatric patient rather than severed epidemiology of acute psychiatric disorders. More focus on innovative crisis intervention programs emphasizing the central role of the general hospital in contemporary psychiatry may strongly contribute to better mental care. Despite significant advances in psychotherapy and medical research such an evolution is contended from the exquisite entropy of psychiatric systems. Those cultural and psychological factors associated with this issue require careful consideration and further studies.

Long stays are often thought to result from outdated methods of treatment, so that modernization should bring them to an end. The purpose of this work is to find out whether old and new long stay patients are to be found in French psychiatric institutions, as they have been in several other countries, and if so, describe some characters of the patients, in order to give a better understanding of the situation. As early as 1972, Wing and Hailey were able to study old and new long stay patients in the Camberwell register. In 1987, Kastrup published the results from the Danish national cohort; among other conclusions, she was able to show that some patients experienced a long stay when admitted for the first time, while others only did so later during the course of their treatment. In 1994, Lelliott and Wing, published the results of a British national audit of new long stay patients; they reiterated that the closing of psychiatric hospitals should go along with the opening of specialised long stay and rehabilitation facilities. Trieman, Leff, and several other researchers members of the Team for the Assessment of Psychiatric Services (TAPS) published many articles describing the follow-up of patients staying in two large hospitals undergoing closure near London. One of these papers concludes that "difficult to place patients will not disappear with the closure of the psychiatric hospitals..., they continue to arise from the population of patients recently diagnosed". At the end of 1998, a national survey was organised according to the recommendations of the United Nations and of the World Health Organisation by the French National Institute of Statistics and of Economic Studies (INSEE). Its general purpose was to describe disabilities in the French population on a census day. To that end, information was also recorded about schooling, employment, income, lodging, family relations, etc. Persons who were notable to answer by themselves were included; if not, many severe cases would have been excluded. A follow-up survey of the same persons took place 2 years later. Interviews were carried out by trained interviewers of the INSEE. Medical information was recorded from what the patients themselves knew or could say. The survey included a random sample of inpatients in psychiatric institutions. We study here specialised hospitals: this does not include psychiatric wards in general hospitals, nor private hospitals. Compared to what had been planned, the proportion of successful interviews in psychiatric institutions was 75%. The 1180 persons who answered the questionnaire bring information about the estimated 33,600 who were in these psychiatric institutions at the end of 1998. Information about where the persons were by 2000 could be collected about almost all of them. This paper deals with length of stay, sex, age, marital status, age at admission, place of residence before entering hospital and outcome at the end of year 2000 All data relating to age and duration were studied by splitting groups into quartiles. No multivariate analysis was made, since information about diagnosis and disabilities was not included. Among the 33,600 in-patients, six out of ten were men. A quarter were under 32 years of age, half under 43. Two thirds of the patients were bachelors. One patient out of ten had been in hospital for 15 days, and one out of five for 30 days; half had been in hospital for 7 months; the duration of stay was over 1 year for 41%, over 5 years for 23% and over 18 years for 10%. Before being admitted, more than four patients out of ten (44%) lived in an independent home, one out of six (16%) lived with his-her parents more than one out of four (28%) lived in another institution. When they were admitted, one patient out of four was 26 years of age or younger, and one out of two was two was 38 or younger. Men, bachelors, and patients between 43 and 54 years of age had longer lengths of stay than the average. Patients admitted before the age of 26, and in particular those admitted before they were 18, had the longest length of stay. Patients who lived in an independent home were in hospital for a much shorter time than those who lived with parents before being admitted. Patients coming from institutions for the elderly had lengths of stay very much similiar to those patients who lived in an independent home before being admitted. In these cases, hospital was for the most part normal place for treatment. Patients coming from institutions for disabled persons had very long lengths of stay. Among the 33,600 patients, one out of ten was living in an institution for disabled persons before being admitted and had been in hospital more than a year. The follow-up showed that among those who had been in hospital for less 16 days by the end of 1998, 6% were in the same institution two years later. For those who had been there for less 41 days, the proportion was 11%. On the other hand, an those who had been in hospital for more than 4 years by the end of 1998, 7% were in an independent home 2 years later. Before being admitted, 44% of the patients lived in an independent home, but only 34% were in such a setting by the end of year 2000. An important minority (43%) was in the same hospital by the end of 2000. The proportion of patients who were in the same hospital 2 years later was higher at younger ages, among those who lived previously with parents, or who came from institutions for disabled persons, or who were admitted before the age of 26. had been in hospital for over 4 years by the end of 1998 and who were in the same hospital 2 years later were admitted at younger ages (eight out of ten were admitted before the age of 38); a large minority (31%) lived previously in an institution for disabled persons. The global death rate in two years was 7%, with a standardised mortality ratio of 4. Patients who lived in an institution for adult disabled persons before being admitted in hospital had a standardised mortality ratio of 10. These data very much suggest that many patients in French psychiatric institutions suffer from severe problems that prevent them from living in an independent home or even in an institution for disabled persons. A large number of persons seem to have been admitted in hospital at a time when it was not anymore possible for them to go on living in the previous setting: after treatment, they were not able to go back to where they came from. Indeed, a survey organised on a census day will over represent the longer stays and the more severe patients. On the other hand, outpatient treatment is very much organised in French public sectorised services, so that it is mainly those who suffer from severe problems who will go to hospital. The data also show that old long stay patients are slowly being replaced by new ones. The splitting of all groups into quartiles shows that there is no clear cut between short and long stay patients. The usual definition (over a year) is simple and convenient, yet is not a definite boundary between 2 separate groups. The analysis of allthese data can be organisedalong2 lines: one approach describes the patients, a complementary one provides information about services. The first approach will underscore the many social abilities that are necessary in order to live in an independent home. Younger age at outset will often be related with more serious mental illness. Considering that marriage usually happens later in our modern society, social withdrawal associated with mental illness will less often be balanced by the family and by relatives, so that patients may tend to stay longer with their parents. On the other hand, the fact that some patients who have been in hospital for a long or a very long time may nevertheless be found in an independent home two years later shows that long stay patients are not neglected. The second approach, about services, draws on the history of French psychiatric institutions: in the past, specialised wards for children were very poorly staffed and received patients with most severe problems. Some of these patients have now become adults and live in the hospital where they were admitted as children. Another question is about how services should be organised so that patients will be able to stay out of hospital despite their severe problems in daily life. A third question is about institutions for disabled persons, who are supposed to provide shelter for patients with disabilities, yet fail to do so for a number of them, so that these persons are admitted to a psychiatric hospital, then cannot leave it. This first French national random survey in psychiatric institutions, with two-year follow up, shows that old and new long stay patients are found in French psychiatric institutions. The results provide information about the patients; they can also help planners in order to improve appropriate services.

Unlabelled: Failure of the French health care services to diagnose and manage problem drinkers has been established on many occasions. This results from a relative lack of knowledge of the basics of alcoholism and the low level of involvement of health care professionals in the management of these patients. In response to this inadequacy, the French Public Health Ministry promoted the development of managed care and coordination of care for these patients. Teams in charge of coordinating care for problem drinkers have been implanted in 96 French hospitals since 1996. These teams aim to provide support to health care providers caring for problem drinkers. For this purpose, they have delivered continuing medical education designed to prepare health care providers to identify and manage these patients in various settings. However, no formal assessment of the impact of these interventions on the knowledge, perceptions, and practices of health care professionals has been planned. The assessment of these interventions can rely on qualitative methods such as observation, focus groups, or individual interviews. However, qualitative methods require specific skills, are time-consuming, and cannot be implemented on a large scale. In contrast, quantitative methods using survey questionnaires or standardized instruments appear to be more appropriate for large scale or repeated evaluations. However, the accuracy of ratings provided by these instruments can be affected by many methodological factors, including the quality of the instrument in terms of validity, reliability, and sensitivity to changes. The aim of this paper is to describe the properties of French and English language questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients., Methods: The instruments were retrieved by searching the Medline, Pascal, and Sudoc computerized bibliographic databases from January 1964 to December 2002. The following medical Subject Headings (MeSH) and text words were used: "*alcoholism/psychology/therapy", "questionnaire", "healthy care surveys", "attitude of health personnel", and "*knowledge/attitude/practice". In addition, the table of contents of the French journals devoted to alcoholism that were not indexed in electronic bibliographic databases were examined (Alcoologie et addictologie, Alcoologie). The bibliographies of relevant articles were also examined for additional citations. Finally, a phone survey of 34 professionals caring for alcoholic patients located in French university hospitals was carried out to retrieve unpublished questionnaires. Two authors independently extracted data from each study using a standard date abstract form. Disagreements were resolved through consensus. They extracted information on the development process and properties of validity, reliability, and sensitivity to changes. Validity is a concept concerned with the extent to which an instrument actually measures what it is supposed to measure. It is assessed through different facets (content, construct, criterion, discriminant, and predictive validity). Reliability reflects the amount of error inherent in any measurement. Sensitivity to change corresponds to the property of an instrument to identify small but clinically significant changes in attitude or practice., Results: A total of 57 relevant publications involving 39 original instruments were identified. Eighty questionnaires were not available, despite the solicitation of their developers. Overall, the study included 21 instruments. Of these, 20 were English-language questionnaires and one was in French. The conceptual frameword was specified for only two questionnaires: "the Addiction Belief Scale" and "the Alcohol and Alcohol Problems Perception Questionnaire". The number of items ranged from 9 to 122. Items were derived from qualitative surveys in only two cases. In the other cases, they were derived from the literature, expert panels, or form unknown sources. The internal construct validity of eight questionnaires was assessed using principal component analysis, factor analysis, or cluster analysis. We considered that external construct validity was analyzed by testing empirical hypotheses derived from the literature for 15 of the instruments studied. Predictive validity cas evidenced for only one questionnaire. Internal consistency was documented for seven instruments, using Cronbach's coefficient. Test-retest or inter-rater reliability was assessed for none of the instruments. The sensitivity to change of two instruments was analyzed. The response rate to the instruments ranged from 46% to 93%., Discussion: The main finding of this study is that properties of validity, reliability, and sensitivity of questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are neglected. Moreover, these questionnaires generally lack a theoretical background. Hence, the interpretation of responses to these questionnaires may be misleading. The present study has several limitations. The search strategy could be criticized for searching only a small number of databases, and selecting French and English language questionnaires. However, given the large range of journals included, it was unlikely that the strategy has limited the generality of the results. In addition, we identified no additional relevant articles by contacting professionals working with alcoholic patients in French university hospitals. Articles reporting instruments designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are incomplete. Journals should require minimum evidence of validity, reliability, and sensitivity when reporting results of surveys, development of questionnaires or standardized instruments., Conclusion: The psychometric characteristics of French language questionnaires were given very little attention. In order to evaluate the effectiveness of their continuing medical education programs, the teams that train French medical staff caring for alcoholic patients should either develop a standardized survey questionnaire following a strict methodology or translate an English language instrument, which would also require a cross-cultural validation.

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Abstract: Objectives: In 1872, George Huntington was the first to describe a genetic disease combining three types of disorder symptoms viz: motor, cognitive – evolving to cortical dementia and psychiatric. The purpose of this paper is to provide a selective review of the major issues and findings concerning suicide in Huntington''s disease. The aim was to understand why patients with Huntington''s disease have a higher suicide rate than those suffering from other neuro-developmental diseases. Materials and methods: The present review is based on a MEDLINE survey of the relevant literature. The terms used in the search were: “Suicide”, “predictive genetic testing”, “suicidal risk factors” and “suicide attempt” all in combination with “Huntington''s disease”. All abstracts were read and potentially relevant articles were examined in full. Various other important cross-references were included. Results: Most of the authors found that suicidal occurrence in Huntington patients was four times higher than that in the general population. No specific individual risk factor was found except a lack of offspring and of psychological support. This review also considered the patient''s attitude towards predictive genetic testing and its results. Reactions varied from psychological relief to paradoxical suicidal resurgence. Conclusion: This paper emphasizes the need of appropriate psychiatric care for Huntington''s patients in order to try to prevent suicidal behaviour. [Copyright &y& Elsevier]

Abstract: Professionals working in a service for young people with gender identity disorder (GID) often experience a particular type of pressure in the course of the work, which makes thinking and decision-making very difficult. The paper suggests that an examination of the position of the professional and of its service within the system may bring some relief and be a starting point to direct thinking and possibly action. The perceived position of the professional and of the Gender Identity Development Service within the wider organisation of a psychotherapy and mental health trust is discussed. The paper makes reference to the model developed by Lagenhove and Harré as described by Campbell and Groenbaek in their book Taking positions in the organisation. The position taken by the professional or the service is also explored as a possible re-enactment of the psychological dynamics of the young people with GID and their families. This view is based on Britton''s paper on the mirroring and re-enactment of individual and family dynamics in the professional network. A view is put forward that this dynamic leads the professional or the service to the risky position of “working at the edge”. The paper discusses processes that could facilitate the move from a position of being psychologically at an edge to the more secure position of being in the mainland. These involve exploration of the model of care and the relationship of the professional to the wider organisation in which the service is located and to self help organisations. [Copyright &y& Elsevier]

This paper reviews articles pertaining to mental health prevention and promotion programs that have used mass media as a component of their program. The programs are analyzed according to four roles that media can play in health promotion programs: promotion, education, complementarity, and support. The relationship between the function assigned to the media and the effects of the programs in changing knowledge, attitudes, or behaviour is explored. When mass media are used alone, they seem to be powerful in recruiting people into groups or social services and in enhancing knowledge and changing attitudes. But when it comes to changing behaviour, mass media by themselves have limited impact. This type of change is more likely to occur when media are combined with face-to-face intervention. Finally, some issues involved in improving the use of mass media in mental health are discussed.

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The paper presents a two-year follow-up of the patients admitted in 1999 in three catchment areas (sectors). By comparing the group of patients who were new in 1999 (N = 321) to the group of those who were already treated (N = 498), the paper describes the type of care received by the patients in 1999, 2000 and 2001 according to age, gender, diagnosis, and type of care. The paper describes the probability of follow up according to the above data. The paper shows the value of a knowledge of the actual pathways of the patients within the psychiatric care organization. [Copyright &y& Elsevier]

This paper outlines the development and implementation of profit sharing, an innovative technique to motivate and empower chronically mentally ill members of a psychiatric rehabilitation program. In some ways, this intervention resembles a token economy. Members are paid script for program participation, which they then exchange for rewards. In contrast to token economies, however, the profit sharing system is financed, administered and monitored by program members. This method has the advantage of enhancing program participation and involvement by allowing members to keep the rewards earned through their own efforts. Data collected over a five-year period suggest that profit sharing increases program utilization, average daily attendance and the number of positive vocational outcomes.

In their work, social workers in mental health services experience a high level of work-related stressors. The literature considers that resilience helps social workers to cope effectively with pressures, learn from their experience and develop personally and professionally. This paper presents the results of a qualitative study involving 16 social workers working with adults with mental and intellectual disabilities in different services in Bihor County. The results of the study highlight the importance of developing resilience as a factor coping with stress. The development of resilience is based on the relationship between social workers and the work environment. Organisations contribute by creating a suitable working environment, offering support, etc. Personal characteristics such as self-esteem, adaptability, hopefulness, sense of humour, coping based on problem approach and less focused on emotions, initiative, creativity, but also social skills and the development of supportive relationships and openness to new experiences, are key elements in this context.

A focus on access to mental health care is critical for beneficent and just care of individuals experiencing homelessness. The delivery of this care is strengthened through building longitudinal relationships between clinicians and persons experiencing homelessness—relationships that are best understood, perhaps, through the lens of attachment theory. In this paper, we look at the prevalence of mental illness among individuals experiencing homelessness and the history of deinstitutionalization of the mentally ill. We then evaluate how three modern-day interventions—street medicine, community health clinics, and supportive housing programs—play integral roles in providing mental health care and constructing a trusting relationship. We conclude with a call for increased funding to support the expansion of these essential mental health care interventions, especially in the aftermath of COVID-19.

This paper deals with the effectiveness of emergency telephonic help services in suicide prevention; it gives an historical account, describes the activity of Geneva's "Main Tendue" and proposes some practical principles on emergency telephonic help. 41 calls of 35 callers of Geneva's telephonic help service are briefly analyzed. A review of the literature available on this subject leaves a pessimistic impression about effectiveness of such services.

The authors introduce in this paper the first results of a catamnestic research performed in 1980 through interviews on 759 psychiatric emergencies in 1978 at the Saint-Luc clinics (Woluwe). A detailed analysis of psychiatric emergencies confronts the researcher to various problems (how and why is the psychiatrist called?) and more philosophically about mental health, therapeutic efficacy or the objectivity of the analysis. The authors also emphasize deontological problems in this type of research and the image of psychiatry and psychic disarray in the practice of emergency. Furthermore, this research brings up various working accommodations. Finally, the authors indicate some future areas of action, in the specific frame of the studied clinic, in order to ameliorate alternatives to hospitalisation in face of a psychiatric emergency.

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Copyright of Lien Social et Politiques is the property of Institut National de Recherche Scientifique (INRS) 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.)

Copyright of Lien Social et Politiques is the property of Institut National de Recherche Scientifique (INRS) 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.)

Abstract: A large number of psychotherapies were proposed to depressed patients. The behavioural and cognitive therapies showed their efficacity. This short-term therapy improves quickly the symptoms and prevent around 30% of relapse. Many patients having suffered from depression undergo unipolar depression relapses during the 5years following the treatment. Therefore international guidelines, including pharmacological and psychological interventions, were published to prevent these relapses. Nowadays a combined treatment is most often prescribed. This paper presents the behaviour and cognitive models of depression. This brief psychotherapy works on the depressed symptoms (engaging the patients in a large number of pleasant activities), on hopelessness cognitions and on the own psychological vulnerability (named cognitive schemata). The activation of depressed schemata is correlated with relapse. The indication of TCC in depressed patient is discussed after two ou three sessions (“case conceptualisation”) performed by a cognitive and behaviour therapist. This professional has preliminary learnt the theory and practice during a specific training. This article reviews main studies including the cognitive and behavioral therapy in depressed uni- and bipolar patients. Results are discussed in terms of acceptability, feasibility, and efficacy. A case study confirms the relevance of this approach. New cognitive and behaviour programmes were developed during 20years with recurrently depressed patients, these included additional booster sessions sometimes combined with well-being therapy and even with mindfulness-based cognitive therapy. The new approaches were assessed in pilot studies and their results will have to be confirmed. [Copyright &y& Elsevier]

Abstract: Psychiatric Intensive Care Units (PICU) propose a secure setting for patients with acute behavior disturbances who can not be managed in psychiatric general wards. Physical violence acts against patients or hospital staff, substance abuse, non-compliance for care and treatment, intensity of symptoms or absconding are frequent motives for admission. Patients are compulsorily detained in secure conditions. They are admitted from psychiatric facilities of a health area or by agreement between hospitals. Multidisciplinary working in psychiatric intensive care is essential, delivered by qualified staff. Care and treatment must be centered on the patient, multidisciplinary, intensive, comprehensive with an immediacy of response to critical situations. As length of stay should not exceed 2 months in duration, interface and liaison with original services of patients are important issues. In France, PICU exist notably at Cadillac, Lyon, Paris, Nice, Eygurande, Montpellier, Pau and Prémontré. These facilities appear as a missing level, an interesting alternative in mental health care system, between psychiatric general wards and maximum security hospitals. This paper reports the creation of a National Association of PICU in France, the existence of national minimum standards and international experiences. [Copyright &y& Elsevier]

Abstract: Impairments in facial affect recognition have been well-established in schizophrenia. Programs of cognitive remediation specifically aiming at correcting these deficiencies are being developed. This paper reviews these programs’ results, and presents a critical perspective on the connections between cognitive remediation and social cognition. [Copyright &y& Elsevier]

Abstract: Background: In May 1978, was voted Law 180, forbidding any new admission in Italian mental hospitals. Many authors set it as an example to be followed in other countries; others contradict this point of view. The purpose of this paper is to analyse the Italian psychiatric revolution in retrospect thirty years later. Method: Several articles and books written by stakeholders and by social researchers were reviewed. Results: The occurrence of the Italian psychiatric revolution cannot be understood without considering the backward situation of mental care in Italy at the time. Changes began before 1978 but were accelerated and shaped by the law. However, some flaws of the previous system have remained over time, most of all, the North-South gap. Discussion: Three points are specially original in Italy and need to be considered before advocating a similar law in another country: first, phasing out psychiatric hospitals went along with difficult problems, second in Italy, local human action is very important, so that implementation of such a law is a bottom-up process, and third, the history of the Italian mental care system has created in the general population a lower propensity to seek care than in other countries. [Copyright &y& Elsevier]

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Abstract: Many patients having suffered from depression undergo unipolar depression relapses during the five years following the treatment. Therefore international guidelines, including pharmacological and psychological interventions, were published to prevent these relapses. Nowadays a combined treatment is most often prescribed. This paper presents the results of cognitive and behaviour therapies in the prevention of relapses in uni-polar depressed patients. A psychotherapy associated with pharmacotherapy resulted in a better prevention than pharmacotherapy alone (with a gain of over than 35%). New cognitive and behaviour programmes were developed during ten years with recurrently depressed patients, these included additional booster sessions sometimes combined with well-being therapy and even with mindfulness-based cognitive therapy. The new approaches were assessed in pilot studies and their results will have to be confirmed. [Copyright &y& Elsevier]

Copyright of Deviance et Societe is the property of Medecine et Hygiene 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.)

Copyright of Cahiers de Recherche Sociologique is the property of Universite du Quebec a Montreal, Department de Sociologie 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.)

Background: In his or her practice, a psychiatrist must often deal with patients who refuse treatment. In 1990, Quebec radically changed this situation by introducing a Civil Code provision imposing judicial intervention to treat an individual deemed unfit to consent, against his or her will. This paper presents an assessment and survey of patients and attending psychiatrists who have used this Code provision.Method: Thirty-nine subjects who explicitly refused treatment were brought to court. We asked a subgroup of these patients to be interviewed, using the Drug Attitude Inventory (DAI), the Clinical Global Impression (CGI), and 2 questionnaires specifically considering the court experience of patients and attending psychiatrists.Results: The results of the survey show that patients remember their experience in court as rather uncomfortable. However, the therapeutic alliance remained unchanged, even after the legal procedure. Physicians agreed that patients would not have been clinically well enough to leave the hospital if they had not received the drug regimen resulting from the court decision. The dissociation between the perceptions of patients and physicians is compared with that found in previous studies in the United States.Conclusion: Even with a limited sample, this study addresses a delicate, difficult situation that professionals are increasingly likely to confront. It also proposes further research on alternatives to judicial intervention. [ABSTRACT FROM AUTHOR]