Canadian
mental health rights in an international perspective
David Norman Weisstub, Julio Arboleda-Flórez
This article surveys the status of people with mental disorders in
the light of international human rights law and assesses if their rights
are respected in the Canadian context. The authors recognize that although
the national systems of countries such as Canada provide significant
civil and constitutional protections on the positive rights of its citizens,
including those who suffer from intellectual disability, the same cannot
be said with respect to entitlements to the provision of social services.
The authors argue that this shortcoming must be remedied. Finally, the
authors conclude that it is paramount to closely monitor the apparent
dissonance between internationally recognized rights to adequate health-care
and freedom from discrimination and their strict application in the
Canadian context.
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Ethical deliberation:
From case study to responsible citizenship
Pierre-Luc Bossé, Paul Morin, Nicole Dallaire
This article wants to be a contribution reflecting on the theme of
applied ethics aiming at nourishing professional and interdisciplinary
practices. The authors examine the process of ethical deliberation which
has four major ends : the development of reflective and ethical com-petences
of professionals, the elaboration by professionals, of an ethical reflective
structure facilitating professional praxis, orientation and quick coordination
of action ; implementation of a structure of collective deliberation
useful in the orientation of difficult decisions and future actions.
Finally, this process also has an objective of evaluation and appears
relevant in the apprenticeship drawn from experiences of each participant.
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Paths of subjects in
the analytical course
Louise Pepin
During the analytical course, not necessarily at the end of the course
of treatment, but as a resort to analysis, at the least as a first step,
in a moment or another during the analytical process, the subject is
called to take an ethical position. The stakes are obviously not the
same in the beginning, at a decisive turning point or again at the end
of treatment, meaning its conclusion. However, the subject cannot avoid
this confrontation where self and self alone, decide to engage or not
in the discovery of his unconcious. Clinical cases illustrate these
turning points. As for the analyst, not giving up on his desire to know,
he maintains the ethics of the psychoanalysis by remaining on the side
of sharpness of truth and he guides his action in order for the subject
to have access to its cause.
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Taking the responsibility
of a ‘knowledge’ one only has access during mental health
consultations: stakes of an ethical issue
Bernadette Colombel
Everyone has a certain knowledge of what psychologically constitutes
him/her. Part of the therapist’s ethical approach is to help this
knowledge come to conscience. Apart from the analytical process, within
one or a few therapeutic sessions, is the person consulting able to
have access to a minimal knowledge about him-herself? Using this knowledge
to guide certain aspects of his-her life, calls upon an ethics of responsibility
on the part of the person consulting. To have this knowledge emerge
demands on the therapists’ part, a concept of the human being
that takes into account subjective dimensions of the person.
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Clinical ethics in
psychiatry: the experience at Douglas Hospital
Camillo Zacchia, Jacques Tremblay
The authors present a brief overview of the clinical ethics committee
within their mental health university institute as well as its evolving
mandates over the past few decades. The main functions include case
consultation, input on elaboration of institutional policy, and staff
education as well as public information on issues of ethics and mental
illness. With examples and questions brought to the committee’s
attention, the authors demonstrate how these functions are intertwined.
The authors conclude that ethical questioning helps examine clinical
practices and serves ultimately in guiding towards best practices in
mental health.
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External supervision of teams is increasingly part of mechanisms put
in place both in public networks and community organizations to contribute
in supporting professional mental health workers in developing their
abilities and improving their clinical practices. It also plays a role
in the analysis of ethical questions and in the prevention of deontological
errors. The supervision of teams also includes its share of challenges,
notably with regards to group dynamics and mechanisms to favour in order
for supervision to rightly adjust to the needs and levels of participating
professionals. Finally, the supervisor must also consider his own ethical
responsibilities towards those supervised and towards their clients.
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Bipolar disorder is a severe mood disorder characterized by recurrence
of mania and depression. Despite the use of mood stabilizers, a significant
proportion of bipolar patients experience relapse, psychosocial impairment
and persistent symptoms. A significant part of patients show poor adhesion
to the pharmacological treatment. This article aims to provide an overview
of research focusing on psychoe-ducational and cognitive-behavioral
treatment (CBT) of bipolar patients. Method: Studies were identified
through Medline searches between 1971 and 2005. Results: Studies on
bipolar patients suggest that psy-choedu-cational interventions may
improve treatment adherence, illness knowledge, ability to cope with
early manic symptoms and tend to reduce the risk of manic relapses.
CBT tends to diminish depressive symptoms, improve treatment adherence
and reduce the risk of depressive and manic relapses. Most psychoeducational
and CBT studies share a common medical model of the illness, thereby
making clear distinctions of impact of each intervention difficult.
Few studies focused on patients with problems with mood stabilizers
adherence. It is now important to develop specific interventions for
those patients. Conclusion: According to these studies, bipolar patients
are likely to benefit from psychoedu-cational or CBT interventions added
to usual pharmacotherapy. In order to overcome limitations of existing
research, future studies should adjust for the effect of pharmological
treatment, the type and severity of psychopathology at baseline, the
acceptance of and the adaptability to the illness and it’s awareness.
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The purpose of this qualitative, exploratry and retrospective study
is to understand the process followed by helping peers during their
experience with a suicidal teenager. Interviews allowed to collect data
with young people who had played this role. An analysis using grounded
theory gave the following proposal: for youths, their experience was
perceived as a heroic mission, first stimulating, then confronting and,
finally, enriching. The experience goes through three stages. The first
begins with the access to the status of helping peer and is pervaded
with the wildly enthusiastic attitude of youth who give themselves the
mission to save a suicidal mate. The second is marked by a certain disappointment
having considered the facts surrounding the mission and undertaken a
fight to save the suicidal mate. At the last stage, after the mission
is completed, an attitude of wisdom stands out when the helping peer
makes the synthesis of his victories and his defeats. The scarcity of
studies on such a controversial subject incites to recommend further
research.
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It is now known that group treatment dropout rate for men who are
violent towards their spouse constitutes a problem. The goal of this
study is to verify if a link exists between attrition in a treatment
for violent men and both partners’s personnal (age, revenue, substance
abuse, having been subjected to violence as children) and marital variables
(dyadic adjustment, anger, attribution, attachment style and violent
behavior). Eighty men enroled in a group treatment for marital violence
have been recruited. Correlational analysis showed us that age is the
only variable correlated with treatment dropout. The younger the participants,
the most likely they were to drop out of the group therapy. These results
will be further discussed.
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This paper presents results concerning the perceptions and attitudes
of Quebec physicians towards patients with schizophrenia and compares
data obtained from a previous poll to data drawn from answers of five
common questions asked to the general population. A short questionnaire
with 5 items selected earlier from a broader questionnaire submitted
to the general population, has been distributed to Quebec physicians.
These items inquired about the perceptions and attitudes of physicians
towards schizophrenia. A randomized sample of physicians was performed.
Three thousand and five hundred (3 500) physicians were selected and
distributed questionnaires. A response rate of 29 %, a little more than
one thousand (1003 responses) was observed, 46 % women and 54 % men.
The authors have found significant diffe-rences between physicians and
the general population in the tendency of wanting to offer help to those
suffering from schizophrenia (physicians = 58 % versus general population
: 45 %). Also, a higher percentage of physicians (72 %) have expressed
feelings of compassion towards patients with schizophrenia versus 27
% in the general population. Results indicate that physicians, with
a family member suffering from schizophrenia, are less comfortable discussing
openly about the family member’s illness (26 % versus 48 %). With
regards to preconception of the severity of schizophrenia, in the field
of health, and more specifically mental health, there are no differences
observed amongst the physicians and the general population.
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