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This article summarizes the consultation process that led to the creation of a «Partenariat» on child sexual abuse of five youth services districts in Québec and five researchers. Statistics on the prevalence of abuse, research on the description of the multiple actors involved in abuse (the victim, the non-abusive parent(s), the abuser and the family), as well as the institutional response to sexual abuse are summarized. A series ofresearch projects are outlined that will respond to clinicians' priorities and meet the multiple methodological hurdles that have plagued research in this area,

AbstractThis article examines support mechanisms for the fathering role. Results come from interviews conducted with 15 fathers and 11 practitioners. Both groups gave their opinion on different services potentially offered to the population of fathers. We also looked at fathers's informal support networks. Results reveal that practitioners have a different idea than fathers about the type of support to offer to fathers. Data on informal support indicate that fathers rely primarily on their spouse for help. They refer much less to their family and friends. They generally don't want to participate in activities organized by social services. The discussion explores the ways in which fathers can receive support from outside the household without threatening their reluctance to ask for help in the context of social services.

Keywords: pères, soutien social, intervention, familles, fathers, social support, intervention, families

The hospital reforms of French health care institutions fall within the scope of the efficient management of the public sector. This paper seeks to describe the oblivion mechanism handled by middle management in an organizational change context through the theory of conventions. The design of the inquiry is based on longitudinal field research conducted over 6 months and is made up of 6 case studies. The results show that oblivion cannot be considered as an empty space to be filled, as suggested by former research. The memory lapse mechanism includes the following steps: reduction, assimilation and gradual integration.

Keywords: Middle management, Oblivion, Theory of conventions, Organizational Change, management Intermédiaire, oubli, théorie des conventions, changement organisationnel, gestión intermedio, olvido, teoría de las convenciones, cambio organizacional

AbstractThis article first presents the context in which are situated governmental orientations regarding measures of control in psychiatric settings such as restraint and seclusion. The authors expose the knowledge concerning the use and the reduction of measures of control and propose three perspectives to guide their reduction and their elimination. The first perspective is oriented towards the control of the violent behavior, the second, guided by a better understanding of the experience of the actors involved in the violent behavior. The third perspective proposed by the authors is directed towards the integration of the trauma as an experience and takes into account the various dimensions of the cycle of violence to which the measures of control contribute. Finally, the authors propose different ways to reduce, perhaps eliminate measures of control in psychiatry.

The One-itis is a play on words derived from American slang that draws an analogy between the love-related feelings and sickness, the terminology of infectious patologies often ending with the suffix « itis ». The use of this expression, synonymous with « obsessive love » is part of a specific context since it has been coined by a group of young men (aged 18 to 35 years) who gather in order to learn to seduce women. This circle, the « Community of seduction », appeared in the late 1990s in California in the wake of emerging self-help and coaching techniques geared towards male seduction. Drawing on empirical observation of the practices and discourse of love of the young men encountered during this investigation, this contribution focuses on the interplay between painful emotional experiences and the standardization and hierarchy of masculinities.

Keywords: amour, capital émotionnel, développement personnel, masculinités, sociabilités et socialisation masculine, love, emotional capital, self-help, male sociability and socialisation, amor, capital emocional, desarrollo personal, masculinidades, sociabilidades y socialización masculina

The mandate of crisis centres varies substantially from one country to the next according to the government policies in effect. In the United States, crisis centres were developed based on Caplan's theory, which defines crisis as a psychosocial disorganization following a life event that is resolved with a return to balance. This approach aims at preventing the onset of mental health disorders through short-term intervention. It is different in Quebec, where crisis centres were developed in a deinstitutionalization context and ought to constitute an alternative to hospitalisation. Such mandate of Quebec crisis centres is not necessarily of the preventive nature associated with Caplan's theory and it has led to services having to be adapted to a heterogeneous clientele that may or may not suffer from mental health problems. It has implications related to the crisis characteristics such as its nature, intensity, and dangerosity, as well as implications regarding the organization of crisis centre services, which have been the object of few studies so far. Objective: The present study aims at distinguishing clinical profiles of crisis centre callers according to the presence or absence of a mental health disorder and its nature, that is severe and persistent (psychotic or bipolar disorder) or not (mood, anxiety or personality disorder). In order to do so, participants are compared on the characteristics of the crisis and the services they received. Method: In this descriptive study, the files of 1170 new assistance applicants are retrospectively analyzed based on a predetermined grid that was used to collect data according to the main clinical characteristics of persons in distress, as recognized in the literature. The subgroup of persons presenting a psychotic or bipolar disorder was examined separately from the one comprising persons with an anxiety, mood or personality disorder because of its clinical complexity, which generally requires intensive, multidisciplinary follow-up. Results: Among the new applicants, 48% had a mental health disorder and, of these, 9% reported a serious mental health disorder, that is, a psychotic or bipolar disorder. The results indicate that having an anxiety-, mood- or personality-type disorder is associated with a higher probability of reporting stressful interpersonal-type events, a more intense crisis, as well as a greater risk of auto-aggressive behaviours. Meanwhile, persons with a psychotic or bipolar disorder are more frequently provided with accommodations and more likely to receive intensive and support services, such as emergency interventions or the use of the Act respecting the protection of persons whose mental state presents a danger to themselves or others (P-38). Conclusions: This descriptive portrait of the crisis centre clientele contributes to the reflection on differential intervention with persons in a crisis situation. It appears important to take an interest in the presence and type of mental health disorders of crisis centre callers, since these characteristics help to better foresee not only the nature and intensity of the crisis but also the type of services required. However, Quebec crisis centres have to respond to the needs of a heterogeneous clientele without having access to a typology and a theoretical model that consider this clinical diversity. Other studies should be conducted to validate, on the one hand, a crisis typology that would make it easier for caseworkers to collect data for evaluation purposes and, on the other hand, a differential intervention model.

Keywords: crise, demandeurs d'aide, centre de crise, trouble de santé mentale, caractéristiques de la crise, difficultés rapportées, services reçus, Crisis, assistance applicants, crisis centres, mental health problems, crisis characteristics, reported difficulties, services received

Objectives: The health and mental health systems in Quebec have recently been substantially transformed. At the heart of this restructuring, reforms aimed to strengthen primary care and to better integrate services, which are central trends internationally. This article summarizes Quebec's primary health and mental health reforms. It also presents the key role of general practitioners in the treatment of mental health disorders and their coordination strategies with the mental health care resources in the province.Methods: Numerous documents on the Quebec health and mental health reforms and the international literature on primary mental health care were consulted for this study. Information on general practitioner roles in mental health were based on administrative data from the Régie de l'assurance maladie du Québec (RAMQ) for all medical procedures performed in 2006. The data was compared with the results of a survey realized in the same year with 398 general practitioners in Quebec. Complementary qualitative data was collected through one hour interviews on a subsample of 60 of those general practitioners.Results: The central aim of the Quebec healthcare reform was to improve services integration by implementing local healthcare networks. A population health approach and a hierarchical service provision were promoted. For a better access and continuity of care, family medicine groups and network clinics were also developed. The mental health reform (Action Plan in Mental Health, 2005-2010) was launched in this general context. It prioritized the consolidation of primary care and shared-care (i.e. increased networking between general practitioners and psychosocial workers and psychiatrists) by reinforcing the role of general practitioners in mental health, developing mental health interdisciplinary teams in primary care and adding a psychiatrist-respondent function in each Quebec local healthcare network. In mental health, general practitioners played a central role as the primary source of care and networking to other resources either primary or specialized health care services. Between 20-25% of visits to general practitioners are related to mental health problems. Nearly all general practitioners manage common mental disorders and believed themselves competent to do so; however, the reverse is true for the management of serious mental disorders. Mainly general practitioners practiced in silo without much relation with the mental health care resources. Numerous factors were found to influence the management of mental health problems: patients' profiles (e.g. the complexity of mental health problems, concomitant disorders), individual characteristics of the general practitioners (e.g. informal network, training); professional culture (e.g. formal clinical mechanisms), the institutional setting (e.g. multidisciplinary or not) and organizations of services (e.g. policies).Conclusion: Unfortunately, the Quebec health and mental health care reforms have not been fully implemented yet. Family medicine groups and networks clinics, primary mental health teams and psychiatrists-respondent are not optimally operational and therefore, are not having a significant outcome. Support mechanisms to help implement the reforms were not prioritized. Hindering factors should be identified and minimized to increase positive changes in the health and mental health systems. This article concludes on the importance of implementing continuums of care, especially local healthcare networks and best practices in mental health. Furthermore, strong strategies to support the implementation of changes should always accompany sweeping reforms.

Keywords: troubles mentaux, soins partagés / soins de collaboration, omnipraticiens, intégration, collaboration interprofessionnelle, réforme de la santé mentale, mental disorders, shared-care, general practitioners (or family physicians), integration, inter-professional collaboration, mental health reform

Objectives. The objectives of this research are: 1) to provide a conceptual framework for analyzing mental health policies; 2) to compare mental health policies across a sample of OECD jurisdictions; 3) to describe configurations of mental health policies; 4) to identify practical implications for the Province of Quebec.Methods. Design: This research is a comparative synthetic study of mental health policies. Sampling: The web sites of the Ministries of health of the thirty-four OECD countries and ten Canadian Provinces were searched for mental health policies proposed within the last fifteen years. Twenty one such policies (with an English or French version) were retrieved, covering thirteen OECD countries, six Canadian Provinces and the WHO. Analysis: Content analysis was performed based on the categories (differentiation, integration, governance) and sub-categories of the aforementioned conceptual framework. Eight policies that together cover the variations encountered between all policies were used to identify typical configurations.Results. A conceptual framework derived from Parsons' Theory of Social Action posits that social action systems must exhibit a level of internal differentiation that corresponds to the heterogeneity of their external environment and also a level of integration that allows them to remain coherent despite the complexity of their environment. Governance mechanisms help them maintain an equilibrium between differentiation and integration.In terms of differentiation, mental health policies exhibit much variation between the needs and the groups that are prioritized (age, gender, ethnicity, culture, etc.), the types of interventions that are proposed (promotion, prevention, treatment, rehabilitation, etc.), the systemic levels at which interventions take place (society, government as a whole, health care system, organizations, programs, individuals), and the level of specification and scientific basis of proposed interventions.In terms of integration, policies promote various mechanisms belonging to four general categories of increasing effectiveness from hierarchical separation of mandates, to exchange of information, to collaborative planning, and to complete structural integration and co-localisation of certain components (ex. dependence and mental health services).In terms of governance, policies present program theories of varying explicitness and scientific bases, and with different emphases on structures, processes or outcomes. Management models also vary in terms of precision, accountability, financing mechanisms, information systems, and the importance of clinical governance and quality improvement.Five configurations of mental health policies are identified (the public health, the professional, the structural technocratic, the functional technocratic, and the political), each comprising typical combinations of the preceding ingredients.Conclusion. The current Quebec mental health policy belongs to the structural technocratic configuration. It specifies fragmented mental health structures with mild integration mechanisms. In the future, it should consider improving its public health aspects (inter-sector work on the determinants of mental health), professional aspects (emphasis on scientific evidence, clinical governance and quality), and functional aspects (integrated specialized community mental health and addiction services). But political factors may prevent it from doing so.

Keywords: politiques de santé, santé mentale, troubles mentaux, organisation des services, intégration, gouvernance, psychiatrie, OCDE, Canada, Québec, health policies, mental health, mental disorders, organization of services, integration, governance, psychiatry, OECD, Quebec, Canada