Points of reference to distinguish case management from Assertive Community Treatment
Daniel Gélinas
The author proposes a synthesis of the essential elements to distinguish case management from Assertive Community Treatment with people suffering from severe mental illness. By situating these two approaches in their social context, the author identifies points of reference that allow to distinguish them one from the other on both practical and conceptual levels. This exercise allows to dissipate the widespread confusion in the literature as well as give clinical workers the necessary tools to identify the appropriate models to meet the needs of the clientele. This also implies taking into consideration the characteristics of the system in which they intervene for its configuration exerts a considerable influence on their work.
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Beyond conceptual foundations
Illustration of a team practice of assertive community treatment
Catherine Vallée, Natacha Courtemanche, Thierry Boyer
The authors propose an overview of the practice of assertive community treatment, from the perspective of its values, its inherent functioning as well as its generic way. Going beyond different models, the authors try to illustrate what distinguishes assertive community treatment from other external or community services. They then present its application with the Service d'accompagnement et de soutien communautaire (SASC) of Pierre-Janet hospital. A vignette written by a client, illustrates the daily and clinical aspects, while structural and organizational aspects are discussed in relation to the regional organization of mental health services.
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The Community Resources Consultants of Toronto (CRCT) : two case management programs
Jennifer Pyke, Louise Nimigon, Vaughn Robertson
This article describes two well established case management services which were developed in response to clearly identified gaps in the mental health system in Toronto. The significance of case management and its place in the mental health system are addressed. CRCT's service philosophy and how that philosophy is put into operation at an organizational level and in the delivery of case management service is described. Client vignettes illustrate the day-to-day work of the case managers and the importance of a strong working alliance.
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Case management : Montréal's West end model
Mario Poirier, Birgit Ritzhaupt, Suzanne Larose, Diane Chartrand
Socio-economic imperatives as well as the necessity to return a clientele in the past institutionalized for long periods of time in their own milieu have contributed to the emergence of new practices. Case management allows to intervene by involving natural and professional networks of support. Various models of case management exist but are often difficult to implement or manage. The model developed in Montréal's west end proposes a flexible, open and decentralized management, gives an important place to the client, and is characterized by the collaboration of all partners.
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Community-based treatment models for adults with severe and persistent mental illness
Mary Ann Test
The author identifies three community-based treatment models for adults with severe and persistent mental illnesses the Program of Assertive Community Treatment (PACT) she has developed over the years with her colleagues in Madison, Wisconsin, the psychosocial rehabilitation center or clubhouse model as well as new consumer run programs and services. She describes the main characteristics of these models and examines results of research in regards to their efficiency to meet the needs of the clientele. Finally, she examines the implications involved for social workers as to their training, these models sharing methods and common values with this discipline.
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The history and spirit of mental health services in Trieste
Giuseppe Dell’Acqua, Massimo Marsili, Paola Zanus
The authors describe the evolution of mental health services put in place in Trieste over the last 25 years. They identify the principles that have led to institutional transformation and to the replacement of the traditional psychiatric hospital with a complete organization of services across the Trieste territory. By defining the spirit presiding over these transformations, the authors describe the variety of services offered. Finally, while the Trieste experience is linked to social and historical conditions favoring its emergence, the authors draw general principles in order to guide and transform the practice of community psychiatry.
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The impact of various levels of social anxiety on the efficiency of a cognitive behavioral treatment of panic-agoraphobia disorder
André Marchand, Marie-Hélène Dion
This research aims at evaluating in individuals suffering from panic-agoraphobia disorder without social phobia the presence or not of various levels of social anxiety. The study also evaluates the impact of this symptomatic comorbidity on the efficiency of two modes of cognitive behaviorial treatment, namely an auto-directed treatment and a treatment directed by the therapist. The study attempts to determine if the application of a cognitive behavioral treatment program positively or negatively influences the various levels of anxiety. On the other hand, the study evaluates if levels of social anxiety influences the efficiency of the cognitive behavioral treatment in regards to agoraphobic symptomatology. The sample includes 51 people (26 in a therapist-directed treatment and 25 in a auto-directed treatment) suffering from DSM-1V panic disorder with agoraphobia. The authors observed a relatively equivalent number of individuals with a panic-agoraphobia disorder presenting social anxiety at a weak, moderate and high level for the two groups in treatment. Moreover, the authors noted a significant improvement not only of the symptoms of agoraphobia-panic disorder, but also of social anxiety symptoms. There are less participants presenting high or moderate levels of social anxiety after treatment. The two modes of treatment are equivalent in regards to their efficiency. Finally, results only partially indicate that high and moderate levels of social anxiety possibly have a negative influence on the efficiency of treatment as measured by certain components of the disorder. Consequences related to this symptomatic comorbidity as well as possible explanations of various impacts of the efficiency of the treatment are discussed.
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Traditional concept of madness and therapeutic difficulties in the Moose of Kadiogo
Jean-Gabriel Ouango, Kapouné Karfo, Moussa Kere, Marcelline Ouedraogo, Gisèle Kabore, Arouna Ouedraogo
The practice of psychiatry in the south of the Sahara in Africa collides with many problems of acceptability of care for the ill and their families. The frequent rejection of the psychiatrist's therapeutic approach can often be explained by the inadaptation of the etiopathogenic approach. Indeed, in black Africa, responsibility of illness differs according to the fact that one has been schooled or not. The western world teaches minorities having the chance to live there or learn about it, that the human body can be assaulted by bacteria, viruses, mycoses or be self-assaulted by changes of its own physiology. Traditional education, for its part, regards the body as a mysterious entity susceptible of being penetrated or eaten by geniuses and anthrophagic sorcerers following a mystico-religious mechanism linked to beliefs and customs. In the majority of the Moose of the Moaga plateau in Burkina Faso, especially regarding madness, these assailants are ancestral geniuses or geniuses from the bush. Psychological suffering caused by a family, social or intrapsychic conflict independent of the invisible world is ultimately delirious for them thus provoking a resistance to give up complete charge of their mentally ill to psychiatric care. For us, an analysis of probable causes of this resistance appeared necessary. Interviews have shown that the psychiatric institution is experienced by the Moose of Kadiogo as a stage in the therapeutic itinerary of their mentally ill, a stage in the course of which their demand for care is reduced to the elimination of inconvenient symptoms. For them, the elimination of the cause derives from a knowledge that psychiatry does not possess, which renders the therapeutic relationship frustrating for both parties.
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The rights of consumers of mental health services : the tight knot of power, law and ethics
Michael McCubbin, David Cohen
Over the past 25 years, in Québec as in the rest of the western world, " mental patients " have become " users " or " consumers ", and laws and procedures have been developed ostensibly to make such change more than merely symbolic. This article suggests that for those users who most need the benefit of "rights", those rights themselves remain as symbolic as the change in terminology. Legal rights are empty gifts if those who receive them do not have the means to exercise them meaningfully. Concern for the legal rights of users must inevitably address the lack of power they experience within the mental health and justice systems. Research is urgently required in order to assess whether and how rights are experienced as concrete and empowering in the lives of users.
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The efficiency of drug addiction prevention programs centered on families
Magali H. Dufour, Louise Nadeau
This literature review examines the efficiency of drug addiction prevention programs centered on families. Many studies underline the determining role of families in the transmission of consumption habits. Moreover, according to many intervenors, the family constitutes a favourable milieu to institute these prevention programs. This article proposes a critical analysis of these programs. The risk factors related to substance abuse with youth are first presented followed by information strategy programs aimed at families, multiple-strategy programs as well as programs aimed at parents who are considered at high risk. A methodological review of evaluative studies is presented. The authors conclude with recommendations.
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