Deena White

Cohesion of the primary social network and sustained service use before the first psychiatric hospitalization

This study analyzed the relationship between social network dynamics and initial help-seeking behaviors. The primary social network was reconstructed for the period beginning with initial observation of unusual behavior and ending with first psychiatric hospitalization. The social networks influence was analyzed based on the concept of social network cohesion, considering both structure and content of social ties. The results demonstrate that networks succeed in referring the family member to services and in maintaining a clinical follow-up to the degree that they are cohesive. When a network lacks cohesiveness, the onset and development of problem behaviors are less easily recognized. These findings confirm the importance of social and interactional contexts in decision-making processes leading to use of psychiatric services and specify the roles they play.

Coordinating community and public-institutional mental health services: Some unintended consequences

Where a target group such as the mentally ill tend to use multiple and varied services over a long period of time, service coordination is often seen as the key to continuity of care. This article argues that coordination also has its perverse effects. To demonstrate, two types of community organizations (COs) working in mental health in the Canadian province of Québec are examined: alternative COs, which have their roots in community action and maintain few formal links with each other or with institutional resources; and transitional structures, COs which are developed with the cooperation of psychiatric professionals, are closely linked to hospitals and are often part of a tightly coordinated system of community services. With respect to access, continuity, programs, internal structure and flexibility, each type of community resource has particular strengths and weaknesses. In the first part of the article, these are described and compared. In the second part of the article, we examine the possible effects of Québecs new mental health policy on COs working in mental health. The policy seeks to create comprehensive systems coordinating all services at the regional level-including alternative organizations, transitional structures and public institutions. The imperatives of the complex planning process risk diluting or even eradicating the differences between the two types of mental health COs described earlier. The process may thus rob certain service users of the particular advantages they found in alternative COs. For those mentally ill who, by choice or by chance, remain marginal to the coordinated system, there may ultimately be no resources available at all.

Family Influence on the First Stages of the Trajectory of Patients Diagnosed with Severe Psychiatric Disorders

This study describes and analyzes the first stages of the care trajectory of psychiatric patients from the standpoint offamily perceptions and actions. Six types of trajectories were identified based on three variables: patients condition and situation, response from health and social services, and family network configuration. Families are central players at the first stage of the care trajectory and long-term preventive intervention conducted by school services or general practitioners have proven beneficial and have permitted a progressive and harmonious entry into specialized mental health care.

The Voluntary Sector, Community Sector and Social Economy in Canada: Why one is not the Other

In the last decade of the twentieth century, the third sector was rehabilitated in a wide range of welfare states. Financed mainly by various levels of government throughout Europe and North America (Salamon et al, 1999), its role as a significant producer of welfare, though never absent, has grown in both importance and legitimacy. In conjunction with this trend, its increasing and potential weight as an economic actor has been strongly emphasized as well, particularly in the French language literature (Defourny & Monzon Campos, 1992; Laville, 1994; Eme et al, 1996; Lipietz & Leborgne, 1998; OECD, 1999; Campbell, 1999; Levesque et al, 2001). Attention is increasingly focussed beyond the sector’s purely social contributions to encompass as well its contributions to the GNP and especially to labour force development. Indeed, as national concerns have taken a decidedly economistic turn compared to the thirty post-war years, the third sector has come to represent a terrain on which the distinction between social and economic policies are most blurred. Its increasing participation in employability development and job creation is seen to respond to social needs and to foster inclusion for the disadvantaged, vulnerable and excluded, as well as to play a significant role in employment / unemployment management and local economic development (OECD, 1998, 2001; Campbell, 1999; European Commission, 2001; Spear et al, 2001).