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Canada is 1.5 times the size of Australia. Australia's population of 20 million is located principally on the east coast. Like Canada, the Australia has a federal system of Government with 5 States and two territories. Each State and territory has its own legislation on mental health. The federal (Commonwealth) Government is responsible for health care planning. In addition, the federal Government subsidizes an insurance program (Medicare) that covers visits to specialists and family physicians, while provincial governments are involved in the provision of hospital care and community mental health services. The Commonwealth government also subsidises the cost of medication through the Pharmaceutical Benefits Scheme. These funds are supplemented by private health insurance. Mental health costs account for 6.5 per cent of all health care costs. Primary care treats the majority of common psychological disorders such as anxiety or depression, while specialist mental health services concentrate on those with severe mental illness. There have been 4 national mental health plans since 1992 with the long term aims of promoting mental health, increasing the quality and responsiveness of services, and creating a consistent approach to mental health service system reform among Australian states and territories. These systematic cycles of planning have first allowed a shift from psychiatric hospitals to community services, from reliance on psychiatric hospitals as pivotal to psychiatric care system. Community care budgets have increased, but overall have decreased with money not following patients; but recent deployment of federally funded through Medicare access to psychotherapy by psychologists for common mental disorders in primary care have increased overall budget. Concerns remain that shift to youth first onset psychosis clinics may come from older long-term psychotic patients, a form of discrimination whilst evidence amount of excess mortality by cardio-vascular diseases and cancers, and due to poverty, poor health prevention and primary health care for these patients. From a system perspective, Australia has been inspired by Canada and created in 2012 its own mental health commission with a similar leading role for patients and families, aboriginal people representatives, but also a surveillance of the system with its own yearly report, like the Quebec Health Commissioner 2012 mental health system performance report.

Keywords: politiques des services de santé mentale, implantation, gouvernance, économique, troubles mentaux graves, troubles mentaux courants, mental health services policies, implementation, governance, economics, severe mental illness, common mental disorders

SUMMARYThe explanatory models of a biological nature are growing in popularity in psychiatry. The reason for this ideological tendency is studied and contradictory evidences are underlined. It seems that an exclusively biological conception of psychiatric disorders is more prescriptive than descriptive of the facts. Biological models, seemingly more "scientific" are particularly of interest to the professionals with a bio-medical training, and, in this sense, bear important implications for the practice of psychiatry. Their influences on clinical practice, professional training and research are reviewed and discussed.

AbstractFor many years, survivors of the Holocaust in Israel and elsewhere have made little space in their lives for past memories. Indeed, they feared being overcome by them and influencing their children negatively as a result. When these people reach the age of putting their whole life into perspective, the mourning and loss processes are reactivated by the need to hold testimony. Also, they seek to be part of the continuity of crucial events that marked their past, particularly concerning the separation from their family of origin, network of friends and cultural community. Furthermore, since people belonging to the second generation grew up with this separation from family roots, they would develop fantasies often linked to a somewhat guilty complex. The authors present two clinical cases to illustrate each of the two themes in the article.

A code of conduct is a set of rules that must be interpreted in light of ethics and clinical principles. Currently, in the province of Quebec, some rules are the subject of very diverse and even contradictory interpretations. This paper aims to analyze three of these problems of interpretation, suggesting what we feel are interpretations that respect both ethics and clinical principles, while hoping to stimulate a healthy debate on these issues.

Keywords: déontologie, éthique, confidentialité, données brutes, dossier, code of conduct, ethics, confidentiality, raw data, professional record

The return to work (RTW) of an employee on sick leave for a common mental disorder can be hampered by various obstacles, including complex or conflictual interpersonal relationships. These dynamics may be accompanied by complex emotions that are poorly regulated or difficult for the employee to identify. Emotion-focused psychotherapy, developed by Leslie Greenberg (2020), offers techniques to promote better emotional regulation, which can support a more harmonious RTW. This article aims to present a set of specific techniques enabling people to deal with the complex and maladaptive emotions that arise in the context of difficult relationships, whether real or anticipated, during RTW. Firstly, the rationale behind working with emotions in psychotherapy and the importance of emotional regulation in a person's functioning will be presented. The techniques of focusing, empty-chair dialogue, and two-chair dialogue will then be explained, together with their specific objectives. These interventions are illustrated using a clinical vignette involving an employee on leave for an adjustment disorder with relationship difficulties with his immediate superior. Although promising, this innovative intervention applied to the specific context of RTW will need to be tested to assess both the employee's emotional functioning and to evaluate the effectiveness of the intervention.

Keywords: retour au travail, trouble mental courant, régulation émotionnelle, dialogue à chaise vide, return to work, common mental disorder, emotion regulation, focusing, empty chair dialogue

Objectives Dropout rates in psychotherapy are known to be high in patients with personality disorders (PD; ranging from 25% and 64% for Borderline PD). Faced with this observation, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD; Gamache et coll., 2017) was developed to precisely identify patients with PD at high risk of abandoning therapy based on 15 criteria, regrouped in 5 factors: Pathological Narcissism, Antisocial/Psychopathy, Secondary Gain, Low Motivation, and Cluster A Features. However, we have limited knowledge about the relevance of self-reported questionnaires commonly used with PD patients to establish treatment prognosis. Thus, the purpose of this study is to evaluate the link between such questionnaires and the five factors of the TARS-PD.

Keywords: trouble de la personnalité, facteurs pronostiques, abandon thérapeutique, psychothérapie, questionnaires autorapportés, personality disorder, prognosis, dropout, psychotherapy, self-report questionnaires

Over the last 10 years or so, public health authorities, particularly through Europe-wide initiatives, have been drawing attention to the economic and existential cost of common mental health disorders, especially depression. These initiatives are taking place at a time when depression is no longer being classified as “just another illness.” The issues involved in these changes are not limited to the institutional realm. We examine some of the changes from the perspective of individual narratives, with an emphasis on the ongoing debate between a naturalizing interpretation of illness and a psychological interpretation that highlights the unique nature of the experience.

Objectives Shame is a painful feeling that one feels when under the impression of having committed an offence or contravened to a personal or moral standard. Shame experiences are often intense and entail a global, negative self-evaluation; persons then feel like they are bad, weak, worthless, or deserving others' contempt. Some people are more prone to shame feelings. Although shame is not listed as a diagnostic criterion of borderline personality disorder (BPD) in the DSM-5, studies suggest that shame is an important feature in individuals with BPD. The aim of this study is to garner additional data to document shame proneness in individuals presenting with borderline symptomatology in the population from the Province of Quebec.

Keywords: honte, trouble de personnalité limite, traits de personnalité limite, psychothérapie, propension à la honte, shame, borderline personality disorder, borderline personality traits, psychotherapy, shame proneness