Normand Carpentier

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.

Support Network Transformations in the First Stages of the Caregiver’s Career

The purpose of this article is to propose a method to facilitate analysis of the processes involved in the transformation of support networks for caregivers of persons with dementia. The authors are particularly interested in the preliminary phases of the caregiver’s career: the initial period ranging from the first manifestations of dementia to the confirmation of a diagnosis. This method combines the social network approach with narrative analysis. The authors discuss two cases to illustrate the concepts of density and clique to explain the maintenance and dissolution of the caregiver’s supportive relationships. This method shows significant potential, in that it will help researchers explore social mechanisms related to the development of supportive relationships.

Using the life course perspective to study the entry into the illness trajectory: The perspective of caregivers of people with Alzheimer's disease

The research community is showing increasing interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimers disease. However, despite this interest, there is little research on the initial phases of the care trajectory. The fact that the first symptoms of dementia are generally noticed by those surrounding the elderly person suggests that the recognition of the disease is intimately linked to interactions not only amongst family members but also amongst friends, neighbours and health professionals. This study focuses on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia. Interviews with 60 caregivers in Montreal, Canada were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Our methods consisted of the analysis of social networks, social dynamics and action sequences. Our findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. We believe that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.

Successful Linkage Between Formal and Informal Care Systems The Mobilization of Outside Help by Caregivers of Persons With Alzheimer’s Disease

Health interventions are currently being revamped to address the specific needs of chronic illness and population aging. In this context, focus has increasingly turned to Alzheimer-type dementia, an illness that is considered to mobilize a large number of social actors into long-term involvement of varying intensity. Linkage problems between families and professional systems have been well documented, yet the reasons for this remain relatively unexplored. In this article, we outline how we used social network data and narrative methods to better understand the linkage processes between formal and informal care systems. We present the trajectories of four caregivers of people suffering from Alzheimer’s disease who were able to establish relationships with resources outside the family. In each of the cases, the dimensions of trust and recognition were central to establishing and maintaining supportive relationships, and must therefore be understood in light of social network dynamics and the broader environment. Although preliminary, this study contributes to the state of knowledge on linkage problems by proposing “bottom-up” solutions that are client centered.

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 Complexities of Help-Seeking: Exploring Challenges Through a Social Network Perspective

Over the past 40 years, scholars have developed a series of models designed to explain and predict the use of healthcare services. The models of the 1960s and 1970s generated copious research in the health departments of numerous universities, partly because of the fact that their standard, variable-centred methodology made it easy for researchers to create questionnaires patterned on the theoretical models. In later years, however, recognition of the growing complexity of modern society caused theorists to propose new models that took a greater number of social phenomena, especially help-seeking behaviour, into account and called for the application of not one but several methodologies. While these new complex models differ from each other on many points, they all attempt to address the following four dimensions: social structure, multilevel effects, culture, and temporality. In this chapter, we discuss these dimensions from the vantage point of social networks. Our approach analyzes the dimension of social structure through network terminology (network structure) and explores multilevel effects through the linkage processes between formal and informal networks (organizational networks). We interpret the notion of culture through the lens of social representations (network content) and we use sequential narrative analysis (network dynamics) to understand the dimension of temporality.

Representations of Elderly with Mental Health Problems Held By Psychosocial Practitioners from Community and Institutional Settings

SUMMARY This article aims to clarify crucial issues pertaining to community and institution-based psychosocial care provided to elders suffering from mental health problems, and to the role of professional and lay systems of beliefs—i.e., representations—in this area of intervention. First, we review epidemiological, clinical, and evaluative data assessing the prevalence of mental health problems (both situational or transitional distress and severe mental health problems, with a special emphasis on the latter) among persons aged 65 and older, the specific situations and needs of this population, and the services provided to them. We then examine three promising and interrelated trends in psychosocial intervention aimed at seniors with mental health problems, that is, practices oriented toward recovery, empowerment, and social integration. Finally, we tackle the cumulative impacts of social representations of aging and the aged and of mental illness and the mentally ill, and how they can impede the implementation of interventions, services and programs based on recovery, empowerment and social integration approaches.

Reconstructing the Temporal-Relational Context: Trans-Action Patterns of Caregivers of an Ill Relative with Alzheimer's Disease

The evolution of a social model of care has been accelerated by a range of factors such as new technology, a change in political parties, and lobbying activity. Further complicating the emergence of the new paradigm is the fact that providing effective care within the community requires an understanding of the context that surrounds the family and the ill person, who must often cope with illnesses that require specialized services and the caring for another persons basic human needs. Using the relational sociology perspective, this study aims to better understand the care trajectory of caregivers of people with Alzheimers disease. We have adopted a methodologically innovative approach that explores two life histories from the viewpoint of social networks, social representations and action sequences. Only once researchers and policy-makers better understand help-seeking processes in the unpredictable context of chronic illness and social life, can they hope to develop social policies adapted to a population whose multiple needs require long-term community care.

Entry Into a Care Trajectory: Individualization Process, Networks, and the Emerging Project

A broad range of services are developing in response to the needs of an aging population. Although most interventions are carried out in the patient’s living environment—at the heart of society—few studies on service utilization refer to social theory. This paper suggests that studies on older people with chronic health conditions would benefit from a stronger theoretical foundation. Drawing on 15 in-depth interviews, it highlights the relevance of individualization processes and the network society, 2 central theoretical concerns in sociology. The research provides a unique perspective on the entry into the care trajectory and expands our comprehension of the emergence of a social organization that can respond to the needs of elderly patients. Data of this nature may be useful in service planning and the development of a care-centered approach.

Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves: perspectives d'intervenants psychosociaux

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to “double stigmatization” targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.