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Many studies report that the use of seclusion and restraint (SR) is experienced negatively by patients who experience feelings of shame, helplessness, and humiliation, and may relive previous trauma events. Since 2000, in Québec, exceptional measures like SR have been framed by a protocol. This protocol provides health care teams with guidelines for relieving, containing, and reducing the suffering caused by SR. We have no knowledge, however, about the views of patients regarding application of the protocol. This study aims to understand the perception of patients regarding application of the SR protocol. For this purpose, a questionnaire was presented to patients (n = 50) who experienced an episode of SR in a psychiatric hospital in Canada. Results show that patients had a nuanced perception of SR: Some felt that SR was a helpful measure, while others felt that SR was not a helpful measure. Patients tended to agree with statements related to the comfort and safety of seclusion rooms and the meeting of their physical needs. Regarding support, they suggested relational, drug, and environmental interventions to prevent seclusion. Finally, nearly all patients perceived that the health care team did not follow-up with the patients after the experience; such follow-up is essential for reconstructing a sometimes confusing event.

This paper explores the experience of families supporting a homeless relative with mental illness. The authors investigate the types of support offered by families; they also examine the relational and personal dimensions which can support a redefining of the role and consequently a modulation of the level of support. Using a qualitative research, semi-structured interviews were realized with 14 family members. The results indicate that housing and the financial support are the types of support most frequently stopped while the emotional and the social support tend to be pursued. The control in the relation, the emotionalism and the perception of future appear as important element for the initiation of a role redefining process.

Family-driven collaboration is fundamental to developing a new model of health care and eliminating fragmented services in mental health. The province of Québec (Canada) recently undertook major transformations of its mental health care system. These transformations represent an opportunity to improve collaboration between families and health care practitioners and to understand which factors facilitate this collaboration. This article describes how families and decision makers perceive collaboration in the context of a major transformation of mental health services and identifies the factors that facilitate and hinder family collaboration., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Context and Objective: Since their creation in 2005 in France, mobile mental health outreach teams (EMPP) have been working to improve the health of the homeless who, for 30 to 50% of them, present severe mental disorders. Their missions are defined by ministerial circular's specifications. Few studies have been undertaken in France to analyze the practices of these teams' professionals, nor the characteristics of the populations with whom they are involved. The EMPP described in this paper had in 2010 a greater staff than other French EMPPs. It has 15 full-time staff, including four doctors (two psychiatrists, one GP, one house physician), two nurses, two educators, one social worker, three peer-workers, one secretary and two coordinators. The article analyzes the way of support developed within the range of EMPP's missions defined by the ministerial circular., Methods: Descriptive statistical analysis was carried out using standardized data from four different sources (round sheet, record of activity, record of hospitalization, housing information, interviews conducted by medical and social professionals with patients). Another source of data consists of records describing the operation of the team (reference framework) and annual activities (annual report)., Results: The method of care was developed based on a street working, involving a full medical and its relationship with the hospital and a place to live in a semi-community context. The Mobile Mental Health Outreach team documented 318 rounds in 2010, describing 666 contacts among whom 87.9% were followed regularly thereafter. It focuses to a target population. The team actively followed 198 people including 161 for whom a psychiatric diagnosis was done: 48.5% of the patients followed presented schizophrenic-type disorders, 21.8% bipolar disorders and other mood-linked problems, 13% behavioral disorders and 6.2% substance-use disorders. A percentage of 44.9 presented with a physical disease. Among the 89 hospitalizations, 86.5% were motivated by psychiatric disorders and 43% were forced. In about one third of the cases, hospitalizations were motivated by a double indication - psychiatric and physical - and in 13.5% for only a physical indication. Thirty people of the actively followed people had stayed in a halfway house as an alternative to hospitalization, restoring a continuity of care and allowing to resolve social problems that had until then been hopeless., Perspectives: The strategies developed by this Mobile Health Outreach Team ensure local community medical, psychiatric and social care for "hard to reach" people. The results confirm the interest of the link between the street work, the hospital and the halfway home, both as a living facility and an alternative to hospitalization. They suggest the importance of a critical minimum size for these EMPP that allows them a street work with doctors providing guidance. The presence of a GP is another welcome development because of the severity and the entanglement of somatic and psychiatric problems of these populations., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The aim of this study is to describe distinct typologies among mentally ill users of resources for homeless people, in order to inform the targeted development of mental health services to address their varied needs. Data came from a survey of clientele of resources for homeless persons in Montreal and Quebec (N = 757) and this study includes the 369 people from this sample who met DSM-IV criteria for serious mental disorders at any point in their lifetime. A hierarchical logistic regression analysis was run with mental health service utilization in the past 12 months (dependent variable), and variables from Pescosolido's Model (independent variables). Cluster analysis identified six types of homeless persons with mental disorders: women; men with schizophrenia; previously depressed or alcoholic men; men with current depressive disorders; men with comorbidity; and men who were previously homeless. Results are discussed concerning the mental health service use, and needs of these different groups.

Objective: To verify the validity of self-reported data on service use from clients with mental or substance abuse disorders in Montreal and Quebec services for homeless individuals., Method: To compare the self-reported data from the Enquête chez les personnes itinérantes (Fournier, 2001) on health service use with official data from Quebec health services (MEDECHO and RAMQ)., Results: The analysis shows a moderate-to-high level of concordance between the self-reported and the official data. Almost every item analyzed presents moderate but significant intraclass correlation coefficients for general and psychiatric hospitalization and use of psychiatric medication, but lower and nonsignificant coefficients for medical hospitalization. Participant characteristics such as mental disorders, homeless status, and substance abuse problems do not seem to have an impact on data validity., Conclusions: The answers on health service use from individuals with mental health problems, homeless status, or substance abuse problems are generally valid in the results presented. Thus the self-reported data from these individiuals seems to be a generally valid source of data and an affordable one for research on service use or other domains.

Improved functioning in the mental health resource network can be guided by cross training procedures involving exchanges of clinical personnel. In 2003, Douglas Hospital along with the Centres locaux de services communautaires (CLSCs) and community organizations in southwest Montreal conducted a pilot project on training exchanges involving 14 clinical teams and 21 workers. Analysis of self-administered questionnaires as well as content analysis of a focus group revealed a very high degree of satisfaction with the project. However, differences of opinion were noted regarding the content and orientation of the training and ways to ensure client confidentiality. The very strong demand for participation in the training courses offered, as well as the high level of satisfaction on the part of participants, testifies to the relevance of new series of personnel rotations. These rotations could be broadened so as to improve the continuity of services offered to people who have concomitant diagnoses of mental health and drug addiction problems.

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