Search

Background: Recovery is emerging as a worldwide paradigm in mental health. There is increasing recognition that the transformation of mental health systems to a recovery perspective requires collaboration among all stakeholders. Research to date has focused on the perspectives of service users and providers. The role and influence of organizational decision makers in the transformation process has been less studied., Materials: This study reports findings from semi-structured interviews with decision makers on the implementation of recovery in Canada., Discussion: Decision makers view community-based services as most open to recovery-based approaches, and front-line providers as pivotal in implementing system change. Decision makers described their own role as limited to providing overall orientation and funding., Conclusions: The shift to recovery must include active leadership from decision makers as a catalyst to change.

"This paper uses pooled 1971, 1981, and 1986 Canadian census data to evaluate the extent to which (1) the earnings of Canadian immigrants at the time of immigration fall short of the earnings of comparable Canadian-born individuals, and (2) immigrants' earnings grow more rapidly over time than those of the Canadian born. Variations in the labour market assimilation of immigrants according to their gender and country of origin are also analysed. The results suggest that recent immigrant cohorts have had more difficulty being assimilated into the Canadian labour market than earlier ones, an apparent consequence of recent changes in Canadian immigration policy, labour market discrimination against visible minorities, and the prolonged recession of the early 1980s." (SUMMARY IN FRE), (excerpt)

Hospital costs for chronic schizophrenic patients consume a major share of the cost of mental health care. Despite the success of numerous community mental health programs, repeated hospital admission of schizophrenic patients is a significant problem. Effective therapy and compliance with that therapy are two important factors in reducing hospitalization. Adverse effects of antipsychotic agents, particularly extrapyramidal symptoms (EPS), negatively influence compliance. A new antipsychotic agent, risperidone, has demonstrated efficacy against both positive and negative symptoms of schizophrenia and has been associated with a low incidence of EPS. To assess the potential of risperidone therapy to reduce the number of days in the hospital, a retrospective analysis was undertaken of data from a year-long clinical trial of risperidone. For 27 patients who had completed 365 days of open-label therapy with risperidone, the number of hospital days during this period was compared with the number of hospital days in the preceding 365-day period, when the patients were receiving conventional antipsychotic medication. The mean number of hospital days was reduced from 106 to 85 days, for a 20% reduction (P = 0.003) after the initiation of risperidone. Three subgroups of patients were apparent: (1) those who had spent no time in the hospital in the pre-risperidone year, (2) those who had been continuously hospitalized in the pre-risperidone year, and (3) those who had spent part of the pre-risperidone year (3 to 165 days) in the hospital. A 73% reduction (P = 0.0009) in mean hospital days (from 49 to 13 days) was achieved in the third subgroup (n = 14). These findings suggest that risperidone may have a role in reducing hospital days for the chronic schizophrenic population.