Canadian Mental Health Research Articles

Review of Canadian mental health law and policy.

JOHN E. GRAY, MARGARET A. SHONE, and PETER F. LIDDLE Canadian Mental Health Law and Policy Markham, ON: Butterworths, 2000, 400 pages (ISBN -0433-43052-4, C$110, Softcover) Reviewed by JOHN HUNSLEY The approach of most psychologists and other mental health professionals towards the realm of public policy and law is perhaps best characterized as one of benign neglect. Most of us concentrate our efforts on conducting research and/or providing services and professional training. Far too infrequently do we attempt to contribute to the shaping of broader policy issues that affect both those who receive our services and our professions themselves. Fortunately, the authors of this book - a policy advisor, a lawyer, and a professor of psychiatry - take their responsibility to inform and guide public debate very seriously. They have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. By their estimates, there are 800,000 Canadians with severe mental disorders (especially schizophrenia and bipolar disorder) whose lives may be touched and, indeed, altered by these laws. For these individuals, their family members, and the health and legal professionals who work with them, this book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. The first quarter of the book focuses on setting the stage for later presentations on Canadian law and policy. To this end, early chapters are focused on providing an overview of Canadian mental health law, historical considerations affecting legal interpretations, and the nature, causes, and treatment of severe mental disorders. This last chapter is rather dated and limited in scope, providing little information on either (i) the important treatment implications (including therapeutic enhancements and reduced side-effects) of the second generation of antipsychotic medication or (ii) the role of psychosocial interventions in reducing relapse and rehospitalization. In contrast, the chapter on historical matters will undoubtedly be of value to those who teach courses on professional standards and ethics. The authors' presentation of how the legal requirement of physical dangerousness supplanted the standard of the need for treatment is particularly compelling, as are their discussions of how the Canadian Charter of Rights and Freedoms might affect mental health law policy and law reform. Most of the remaining chapters, comprising the majority of the text, focus on specific mental health laws dealing with (i) involuntary hospitalization, admission procedures, and treatment requirements, (ii) conditions for refusing treatment, (iii) assisted community treatment, (iv) legal safeguards for patients, (v) mandated services, and (vi) psychiatric issues in the Canadian criminal justice system. Taken together, these chapters provide information on the Mental health acts of each province and territory, the mental disorders provisions of the Criminal Code of Canada, and the numerous adult guardianship, substitute decision-making, and consent to health care laws. …

Improving accessibility: the experience of a Canadian Mental Health Agency.

This article describes the process undertaken by a community mental health organization in Toronto, whose staff are predominantly white and unilingual, to be more accessible and responsive to Toronto's diverse ethnic communities. Board, staff, and consumer input provided guidance for the development of antidiscrimination and antiracism policies, and subsequently for expectations that each program find ways to implement these policies. The article focuses on events and opportunities of one of the programs that led to connections being established between the organization and the Somali community.

Review of Abnormal psychology perspectives.

WILLIAM L. MARSHALL and PHILIP FIRESTONE Abnormal Psychology Perspectives Toronto, ON: Prentice-Hall Allyn & Bacon Canada, 1999, xxv + 598 pp. (ISBN 0-13-589748-3, C$90.95, Hardcover) (Study Guide: ISBN 0-13-589772-6, C$21.95) Reviewed by HARVEY P. MANDEL and WENDY HAMPSON Those of us who teach abnormal psychology to Canadian undergraduates have been waiting for a textbook like this for far too long. Until now, Canadian faculty had to choose among a number of well-written American texts and then augment the text with Canadian readings. It is not that Canadian research is absent in American textbooks. Often it is blended into the presentation of scientific evidence. Some Canadian work is excluded routinely, simply because American texts focus primarily on the American mental health scene. What is lost is an exploration of the unique characteristics of Canadian mental health. But how should a Canadian textbook in abnormal psychology be constructed? One way would be to adapt an American text, adding and highlighting Canadian studies. However, that would not capture the broad context of the Canadian mental health scene. In order for a Canadian text in abnormal psychology to make a unique contribution, it should do two things. At its core, it must first address the Canadian experience in mental health and place it within a larger international context. It would have to reflect the history of Canadian mental health care, describe our delivery of mental health services, discuss our unique legal practices, explore the relationship between multiculturalism and mental health, provide Canadian statistics on such things as the prevalence of suicide across Canada, and examine Canadian programs for the prevention of mental illness. Second, it would have to include all of the major components of U.S. texts (i.e., up-to-date coverage of topics, multiple modes of data presentation, controversial issues and opposing points of view, a comprehensive glossary of technical terms, a study guide for students, an instructor's guide, a computerized record-keeping system and test bank for instructors, and a competitive price). The publication of Abnormal Psychology Perspectives goes a very long way in providing many of these components. Marshall and Firestone have chosen to construct an edited text, using Canadian experts for each of the 19 chapters. Marshall is an author or co-author on four chapters and Firestone on five. They required that all contributors adhere to a template. For example, all 19 chapters open with a brief case history, followed by an overview of the content of the chapter. Except for chapters on Therapies, Mental Health Law, and Prevention and Mental Health Promotion in the Community, each chapter contains sections on diagnosis and DSM-IV criteria, historical information, descriptions of the disorders, followed by information about etiology and treatment. Each chapter concludes with an overview of the material presented, a summary, and a listing of key terms and additional resources. The last section in each chapter provides one of the most interesting and worthwhile guides to additional resources through the listing of Canadian and international websites that students can access if they choose to pursue a topic in greater depth. Because of these organizational consistencies, the reader can progress relatively seamlessly across chapters written by a range of experts. Chapters 14 cover history, theoretical perspectives, classification and diagnosis, and assessment and research methods. Chapter 5 (Disorders of Childhood and Adolescence) and Chapter 6 (Developmental Disorders) appear before any of the adult disorders are presented. Many textbooks in abnormal psychology place disorders of childhood and adolescence at the end, usually just prior to the chapter on disorders of aging. The current positioning allows the reader to absorb the information following a life-span developmental perspective. …

Symposium: Our Past, Our Future Notre Passé, Notre Avenir

Symposium: Our Past, Our Future Notre Passé, Notre Avenir

Safe beds: the new partner in Niagara's crisis system.

Over the past few years and for a variety or reasons, consumers/survivors in the Niagara Region have indicated that an alternative to hospitalization is needed. This paper describes the community-development process which led to the creation of a crisis-response system consisting of Community Crisis Care (CCC) and a Safe Beds program operated by the Canadian Mental Health Association St. Catharines and District. The system is described, as well as the partnerships that are critical to the program's success. Evaluative data are presented along with a discussion of critical learnings. Future considerations for program improvement also are discussed.

The first asylums in Canada: a response to neglectful community care and current trends.

Humane treatment and care of mentally ill people can be viewed from a historical perspective. Intramural (the institution) and extramural (the community) initiatives are not mutually exclusive. The evolution of the psychiatric institution in Canada as the primary method of care is presented from an historical perspective. A province-by-province review of provisions for mentally ill people prior to asylum construction reveals that humanitarian motives and a growing sensitivity to social and medical problems gave rise to institutional psychiatry. The influence of Great Britain, France, and, to a lesser extent, the United States in the construction of asylums in Canada is highlighted. The contemporary redirection of the Canadian mental health system toward "dehospitalization" is discussed and delineated. Early promoters of asylums were genuinely concerned with alleviating human suffering, which led to the separation of mental health services from the community and from those proffered to the criminal and indigent populations. While the results of the past institutional era were mixed, it is hoped that the "care" cycle will not repeat itself in the form of undesirable community alternatives. Severely psychiatrically disabled individuals can be cared for in the community if appropriate services exist.

Refugees' time perspective and mental health.

The authors' goal was to investigate factors protective of the mental health of refugees, with a particular focus on time splitting and suppression of the past. Structured interviews covering premigration and postmigration stresses, personal and social resources, and mental health were given to 1,348 Southeast Asian refugees resettled in Vancouver, British Columbia, and to a comparison sample of 319 residents of Vancouver. Both groups of subjects also performed a task designed to measure orientation toward past, present, and future. Compared with resident Canadians, refugees were more likely to exhibit an atomistic time perspective in which past, present, and future are split. Temporal atomism and avoidance of nostalgia were associated with a lower risk of depression than were other time perspectives. Under conditions of extreme adversity, time splitting and suppression of the past may be adaptive strategies, mitigating the risk of depression.

The prevention of mental health problems in Canada: A survey of provincial policies, structures, and programs.

AbstractThe purpose of this research was to obtain a profile of state of prevention in mental health in Canada. In all provinces and territories, we obtained information from departments of children's mental health, adult mental health, and health promotion regarding administrative supports, personnel, policies, budgets, inter - ministerial collaboration, training, and programs allocated for prevention. The findings indicate that rhetoric of prevention is present in many government policy documents and there are many interesting prevention projects that have been implemented. However, there has not been a reallocation of funding in health field from treatment and rehabilitation services to prevention programs, and funding for prevention remains a very low level. Recommendations to improve state of prevention are made.There is abundant epidemiological information to suggest that psychosocial problems will never be brought under control by treating affected individuals one a time. As Offord recently put it, the of suffering from child psychiatric disorders is extremely high, and one - to - one clinical interventions can never make a large dent in reducing this burden (1995, p. 287). Kramer (1992) recently documented what he called pandemic of mental and emotional disorders, demonstrating that prevalent global social trends such as population growth, poverty and family breakdown are resulting in exorbitant numbers of children and adults suffering from one psychosocial problem or another. Using a conservative estimate of prevalence rate of 12% for mental, behavioural and developmental disorders in children around world, Kramer reports that the total number of cases of mental disorders in children under 18 years of age would increase from 237.8 in 1990 to 261.5 in year 2000, increase of 10%. In more developed regions number of cases would increase from 37.8 to 38.2 million (Kramer, 1992, p. 15). In his review of epidemiological studies for child psychiatric disorders, Offord (1995) states that based on DSM - III criteria, five community studies reported prevalence rates of 17.6% to 22%. A Canadian study estimated that approximately 26% of school - age children experience mental health problems (Offord, Boyle, & Szatmari, 1987). Although prevalence rates for psychological problems vary depending on informants, instrumentation, and definitions of disorders, Offord estimates that at very least, 12% of children and adolescents have clinically important mental disorders, and least half of them are deemed severely disordered or handicapped by their mental (1995, p. 285). This figure is congruent with one reported by Institute of Medicine (IOM) (1994), according to which least 12% of children in U.S. from one or more mental disorders - including austim, attention deficit hyperactivity disorder, severe conduct disorder, depression, and alcohol and psychoactive substance abuse and dependence (p. 487). The same report states that 20% of adults in U.S. actively suffer from a psychiatric impairment, and 32% can be expected to develop such illness during their life time.Even in a utopian scenario in which therapeutic interventions would be successful 100% of time, there would never be enough mental health professionals to reach all those in need (Albee, 1990). Moreover, as Albee (1990, p. 370) has noted: ... as history of public health methods (that emphasize social change) has clearly established, no mass disease or disorder afflicting humankind has ever been eliminated by attempts treating affected individuals. This realization, coupled with simple yet powerful notion that an ounce of prevention is worth a pound of cure, has led governments and mental health professionals to develop prevention and mental health promotion programs.In spite of this clear need to shift to a more preventive orientation, governments have not provided infrastructures that are needed for advancement of primary prevention in mental health (Goldston, 1991; IOM, 1994). …

Facing the challenge: Mental health and illness in canadian youth

Abstract Abstract The current status as to the prevalence of child and adolescent mental health and illness problems worldwide was reviewed with particular emphasis on: indicators of changes in prevalence; the effect of time on prevalence and the relatively higher risk status for adolescents; and the extent of mental health service utilization. The Canadian perspective on youth mental health was examined with a presentation of data from the Canadian Mental Health and Illness Survey. This survey evaluated ‘mainstream’ youth's knowledge, attitudes, and behaviours relative to mental health and illness, self-perceptions of functioning and coping mechanisms, service utilization patterns, and the perceived barriers to accessing and utilizing the existing mental health system. Results suggested that Canadian youth is experiencing significant levels of distress, with females and older adolescents at greater risk. In spite of these difficulties, youth reported limited reliance on traditional mental health systems....

The multiconstitutency approach to organizational performance assessment: A Canadian mental health system application

This papers applies a multiconstituency approach to assessing organizational performance in Canadian general hospital psychiatric units and provincial psychiatric hospitals. In the absence of reliable and valid outcome measures, researchers and administrators have increasingly considered the views of external constituencies as a means of both defining the criteria for effective performance and actually assessing organizational performance. Key constituencies included psychiatric unit staff, psychiatric hospital administrators, and directors of community agencies providing mental health and related services. Opinions about organizational roles were found to exist among constituencies and among professional groups. Perceptions of organizational performance were highest for primary roles and substantially lowest for roles of secondary importance to the constituency. Future analyses of this type could help to validate the use of both constituency measures and more traditional performance measures. While constituency views may be seen as subjective, they are nevertheless key to building effective mental health service delivery systems.

Out to pasture: a case for the retirement of Canadian mental health legislation.

The emergence of new adult guardianship and related legislation and systems in British Columbia, Ontario, and other jurisdictions has generated questions about the utility of separate mental health legislation. Mental health statutes are the descendents of legislation that once created and regulated separate institutions and systems for the insane (later known as the mentally diseased and, more recently, the mentally ill). Such legislation is no longer consistent with the dominant community care and treatment strategies in the mental health field and the growing trend to recognize and respect consumer involvement in care and treatment decision making. Emerging legislation in the guardianship field makes provision for a range of options and mechanisms that can replace separate mental health statutes (e.g., general consent to health care legislation, and provision for enduring powers of attorney of the person and Ulysses agreements) and produce a new and more effective legal framework for the provision of mental health care and treatment.

Different Systems, Shared Challenges: Assessing Canadian Mental Health Care From a U.S. Perspective

(1993). Different Systems, Shared Challenges: Assessing Canadian Mental Health Care From a U.S. Perspective. American Review of Canadian Studies: Vol. 23, No. 1, pp. 65-82.

Frequency of seasonal affective disorder among individuals seeking treatment at a Northern Canadian mental health center

The frequency of seasonal affective disorder (SAD) was examined in clients receiving treatment for recurrent mood disturbances in a northern Canadian site. Approximately one-fifth of these individuals were identified as having SAD when file histories and a statistical criterion were used as the basis for assessment. The failure to find a higher prevalence rate at this latitude may be due to other studies' reliance on client self-report, a tendency for individuals with SAD to relocate south, or a greater tendency for clients with SAD to be seen by general practitioners and alcohol treatment centers in the north.

Sharing Household Labour: “Could You do the Bedtime Story While I do the Dishes?”

The Canadian Mental Health Association (1987) identified the double workday as a major source of stress for women. Drawing on a socialist-feminist analysis, we examined the inequalities in the workloads of men and women in different stages of family life. The data from 223 service sector workers in the Canadian airlines industry were analyzed through multivariate analysis of variance techniques. Results indicated gender inequalities in total workloads as well as types of work. Men and women did equal amounts of child care but women did significantly more housework.

Economic Evaluations in the Canadian Mental Health System II: From Theory to Practice in Mental Health Care*

This paper follows from a previous paper which described the basic approaches to economic evaluation of health programs. The discussion in this paper builds and discusses the theoretical and practical concerns felt by practitioners and analysts about economic evaluations in mental health care. Two examples of economic evaluations that compare the costs of hospital care and community-based care are presented to illustrate some of the limitations of economic evaluation. Discussion also focuses on the difficulties involved in developing and conducting economic analyses in the mental health field, as well as problems faced in trying to generalize from one study setting to others.

Economic Evaluations in the Canadian Mental Health System I: Theory behind Economic Evaluation*

Economic evaluation is becoming an increasingly important part of the evaluation of health and mental health services. Current models for conducting economic evaluation, including cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, have great potential for improving the quality of decision-making and for making mental health programs more effective and efficient. This paper presents the basic economic theory underlying the various forms of economic evaluation and provides general guidelines for developing and conducting an economic analysis of a health program.

Viewpoint: development of mental health services and psychiatry in Canada: lessons from the past: problems of the present; and the future.

The history of mental health services in Canada has been characterized by great frustration for those dedicated to the development of programs to meet the needs of the mentally ill. Acceptance of these services by the public at large has been limited and characterized by suspicion and lack of trust. In recent decades these two trends have contributed to the present situation in which it is difficult to recruit competent, well-motivated clinical staff for our more isolated mental hospitals and there is increasing emphasis on legalistic aspects of individual civil rights, compulsory treatment and related factors with little attention to the patient's entitlement to and need for adequate treatment. It is hypothesized that more understanding and progress may come from an insightful review of the historical development of Canadian Mental Health Services and the goals of organized Psychiatry in Canada than will result from developing a defensive and confrontational attitude towards current events in the field.

The impact of the Canadian Charter of Rights and Freedoms upon Canadian mental health law: the dawn of a new era or business as usual?

Canadian mental health law has traditionally held many themes in common with the mental health law of other Commonwealth countries such as Britain, Australia, and New Zealand. Until recently, this body of law bore only a passing resemblance to the system of mental health law that has emerged in the United States.The existence of an entrenched Bill of Rights in the United States has meant that many major issues relating to the rights of mental health patients have been dealt with as constitutional matters of great import. Consequently, the 1960s and 1970s witnessed the burgeoning of an exciting body of case law establishing a number of critical rights for a constituency that had hitherto been powerless and tragically neglected. While many of the rights established in the so-called landmark cases were subsequently limited in their scope or were just not affirmed by the appellate courts, the widespread use of constitutional challenges by mental health advocates wrought wholesale changes in both federal and state legislation and permanently altered the balance of power between mental health professionals and their patients.

Mental health professionals' knowledge in the field of caring for chronic mental disorders.

A national sample of 246 Canadian mental health professionals was given a knowledge test concerning principles of care for chronic mental patients. Results showed that: (1) mental health professionals were moderately knowledgeable on this topic (mean score 66%), (2) errors made were more commonly in the direction of over-enthusiastic support for the community approach and (3) there were no differences in knowledge scores by a demographic or professional status variables included in this study.

The Adjustment of a National Voluntary Association to Change in Its Environment: The Case of the Canadian Mental Health Association

The Adjustment of a National Voluntary Association to Change in Its Environment: The Case of the Canadian Mental Health Association