Paul C. Whitehead

Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment.

Objective: To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period. Method: We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services. Results: There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period. Conclusions: Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.

Occupational Factors in Alcoholism

The relationship between occupations and alcoholism received considerable attention during the 1970s, mainly because of the ascendancy of the idea that the potentially most favorable intervention with the problem drinker could take place through identification in the workplace. This idea is not a direct concern of this chapter. Rather, we are interested in the role of occupations in the psychosocial pathogenesis of alcoholism. Occupational roles are a dominant force in many aspects of social life in Western societies as well as in other societies. To the extent that this force is associated with a number of social concerns ranging from population dynamics and rates of divorce to rates of suicide and other forms of self-destructive behavior, understanding its role in the etiology of social problems is important and useful.

Acupuncture in the Treatment of Addiction: A Review and Analysis

Many claims have been made about the usefulness of acupuncture as an analgesic and in the cure of certain conditions. The background of some of these claims is examined as are alternative hypotheses for some of the observations that have been reported. The studies that have served as the basis of much of what has been said and written about the use of acupuncture in the management of addictions are reviewed and found to fall seriously short of adequate clinical trials. The utility of acupuncture remains unproven, and some directions for future research are suggested.

Sex and Age Patterns in Self-Injury*

Age and sex differences in rates of self-injury are prominent and relatively unexplained. A prospective study of self-injury patients resident in London, Canada was carried out between 1969 and 1971. It wasfound that rates of self-injury are higherforfemales andforyoung persons, compared with suicide rates which are higherfor males and for older persons. Other factors related to rates of self-injury are also examined, but the basic age and sex patterns persist when these variables are controlled. These findings indicate that self-injury among the young, especially young females, has considerably less lethal risk than among older persons, especially males. For this reason, self-injury may have rather different motivation and be surrounded by different circumstances that serve to differentiate the classes of events. A preliminary theoretical model is proposed which relates self-injury to suicide and other forms of reaction to stress. The study of suicide and attempted sui- cide has long exerted a strange fascina- tion for scholars, which has resulted in more study than the subject matter has seemed tojustify either as a cause of death or as a problem of social importance. Only in recent years has the extent of self-injury behavior in the population begun to be uncovered. As a result, students of this subject are becoming aware that self- injury is much more common than they had thought, hence a greater cause for concern. For example, a Canadian pro- spective study of self-injury behavior in London, Ontario, recently reported a rate of 730 cases of self-injury per 100,000 population, a rate several times highei than is usually associated with this * This project was supported by grants from the following sources: The Ontario Mental Health Foundation (#241); the Public Health Research Grants Division of the Department of National Health and Welfare (#605-7-585); and the Canada Council (#573-0294-51). phenomenon. Moreover, evidence sug- gests that actual rates of self-injury in the population may be as high as 1400 cases per 100,000 population per annum (Whitehead, Johnson and Ferrence, 1973). According to these reports, the high rate in London probably does not reflect a high propensity for self-injury in the local population. Rather, it indicates a more complete description of existing patterns of the incidence of self-injury (Ferrence and Johnson, 1974). If the unknown but reputedly much higher rates of threatened self-injury are added to these known rates, we begin to become aware of the importance of self-injury as a technique in human relations. Of the many areas of analysis of suicide and self-injury that are reported in the literature, the interrelationships of sex and age comprise one of the most intri- guing sub-sets for potential further study. The purpose of this paper is to report and

Multidrug Use: Supplementary Perspectives

The phenomenon of multiple drug use has been examined for a number of different types of groups ranging from “normals” (Blum et al., 1969) to psychiatric patients (Frosch, 1969; Rockwell, 1969; Rickels and Brand, 1969) to opiate users (Lucas et al., 1972). Most attention has been devoted to marihuana smokers (Goode, 1969; Whitehead et al., 1972; Grupp, 1971). Each of these studies has found high rates of multiple drug use among the populations in question. That is, each study suggests that users of any one drug are more likely to use other drugs than those who do not use that drug. However, the validity of this conclusion has yet to be tested for a variety of other types of drugs, e.g., alcohol, tobacco, and speed. Previous studies suggest that there may be some etiological significance that is attached to the use of a drug in terms of increasing the probability of using other drugs. However, this needs to be further examined in terms of other substances, and this is the purpose of this paper.

An evaluation of the impact of daytime running lights on traffic safety in Canada

Since December 1, 1989 all new cars sold in Canada were required to be equipped with daytime running lights (DRL). This policy was expected to reduce angle and opposing collision involvement by 10% to 20% by making cars more conspicuous, thereby increasing the window of opportunity within which drivers can react. A quasi-experimental comparative posttest design is used in this study to evaluate the impact of DRL legislation on the incidence of angle and opposing collisions for 1989 cars and 1990 cars in the 1991 calendar year. The results show that the combined incidence of the two types of collisions is reduced by 5.3% ( p p

Sex Differences in Psychoactive Drug Use

The study of sex differences in the use of psychoactive drugs is particularly appropriate and timely for several reasons. Prior to the late 1960s, epidemiological studies of the incidence of drug-using behaviors were few in number. The socially significant increase in the use of illicit drugs during the late 1960s and early 1970s stimulated the collection of a sizable body of data on drug use throughout North America. These data offer an opportunity for retrospective analyses of drug-using behaviors.

The Uses of an Epidemiology of Drug Use: The Canadian Scene

Epidemiology began as the science of epidemics originally investigating the source, spread, and control of communicable diseases (Rogers, 1965). This remains an important function in many parts of the world, but in North America more attention is given to epidemiological studies of noncommunicable diseases. A further novelty is the application of epidemiological methods to behavioral pathologies such as mental illness, drug abuse, and drug use in which physical illness is a minor element. Broadly speaking, epidemiology is “the study of all factors (and their interdependence) that affect the occurrence and course of health and disease in a population” (Rogers, 1965). It is this broader definition into which current studies of drug use fit since they only rarely bear upon disease or pathology. Such studies have been, at times, concerned with the incidence of drug use— the number of new users during some given period of time (usually 6 months or 1 year) — but mainly they have attempted to produced estimates ...

Explaining unsafe sexual behaviour: Cultural definitions and health in the military

This study examined the reasons why military personnel in the Canadian Forces (CF) engaged in risky sexual practices despite their knowledge acquired during educational/informal training programs. Analytic induction and grounded theory were used to generate and test their explanations. Interviews were first conducted with seven key informants and later with 71 members of the CF in order to formulate, test and reshape hypotheses accounting for heterosexual acts without the use of condoms. Findings suggest that unsafe sexual behavior were not viewed as irrational or deviant. Rather, they were considered meaningful for the individual concerned and conformed to certain cultural ideals. Unsafe sexual practices were rooted in localized socially constructed meanings of sex, risk and relationships within the military. The meanings have implications for the ways in which public health information was taken up and used by armed forces personnel, and led individuals to put themselves at risk of HIV infection and other sexually transmitted diseases in certain social contexts. This relatively new explanation of taking sexual risks forms the basis for programs and interventions of a type not hitherto tried in armed service environments.

The Time to Combine: Epidemiological Similarities off the Use and Abuse of Alcohol and Other Drugs

In many quarters there remains a resistance to integrating research and preventive efforts relative to alcohol and other types of drugs. Alcohol and other drugs are treated as separate and distinct phenomena that have little relevance for each other. The objections to developing combined programs are typically based on what are perceived to be important differences among different types of drug-using phenomena. While it is true that the psychopharmacological effects of various substances are different, and that the societal reactions to abuse of different substances may vary, and that the legal status of alcohol and some other drugs is different and that patterns of use may be different [1], this does not mean that there is an absence of strong epidemiological similarities that might form a sound basis for more integrated approaches to efforts in the areas of research and prevention. The purpose of this paper is to examine recent epidemiological research that strongly indicates the existence of important ...