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In Canada, at least 5 percent of the population suffers from a serious, persistent mental illness such as schizophrenia or bipolar disorder. While recent years have seen many changes and improvements in the way we respond to the needs of mentally ill persons, there remain divisions of opinion among stakeholder groups about the way mental health services are delivered. Community Mental Health in Canada offers a timely, critical overview of the provision of public mental health services in Canada, looking at where we have come from, the current situation, and where we may be heading. Concise, yet comprehensive, coverage includes: the prevalence and impact of mental illness in Canada the complementary and conflicting interests of stakeholder groups, such as mental health professionals, clients, families, government, and drug companies current and developing initiatives in treatment, rehabilitation, housing, and criminal justice programs the clinical benefits and costs of particular interventions, among them pharmacotherapy and cognitive-behavioural treatments the recovery model diversity and cultural competence the legal and ethical basis of mental health practice, particularly as it applies to the use of coercion and involuntary treatment Community Mental Health in Canada fills a gap in the literature in its analysis of both clinical mental health practice as well as the structural context within which it is situated. An indispensable resource for students, practitioners, and policymakers, it also is essential reading for all those interested in how services are provided to our most vulnerable citizens.
The primary objective of this book is to provide comprehensive descriptions and make comparative evaluations of each of the mental health systems of four Western, industrialized countries. The countries selected illustrate a continuum from a highly centralized and publicly financed, national health service in Great Britain to a predominantly decentralized and more privately financed market of mental health services in the United States. In between these two contrasting types are examples of national health services and insurance programs in Norway and Canada. Contributing experts from each country begin their chapters with an overview of the geographic, demographic, political, economic, and cultural contexts in which their mental health systems are situated. Thereafter, they (a) present national data to estimate the need for mental health services, (b) describe national mental health policies and programs designed to meet their population's need, (c) indicate how mental health services are organized and delivered, and (d) discuss how their system is financed and provided resources. A common chapter outline facilitates comparisons among all four systems on relevant evaluation criteria: (a) access and equity, (b) quality and efficacy, (c) cost and efficiency, (d) financing and fairness, (e) protection and participation, and (f) population relevance. In the final section of each chapter, the authors provide recommendations for improved performance of their mental health system. In the initial chapter, the editor provides an overview, introduces the four countries selected, and defines the evaluation criteria applied by all contributing authors. The final two chapters address convergence and divergence among the four systems and provide recommendations for improvement and for future comparative studies. The intended audience includes mental health policymakers, program administrators and managers; teachers of graduate level courses relat
In Mental Health and Canadian Society leading researchers challenge generalisations about the mentally ill and the history of mental health in Canada. Considering the period from colonialism to the present, they examine such issues as the rise of the insanity plea, the Victorian asylum as a tourist attraction, the treatment of First Nations people in western mental hospitals, and post-World War II psychiatric research into LSD.
Human migration is a global phenomenon and is on the increase. It occurs as a result of 'push' factors (asylum, natural disaster), or as a result of 'pull' factors (seeking economic or educational improvement). Whatever the cause of the relocation, the outcome requires individuals to adjust to their new surroundings and cope with the stresses involved, and as a result, there is considerable potential for disruption to mental health. This volume explores all aspects of migration, on all scales, and its effect on mental health. It covers migration in the widest sense and does not limit itself to refugee studies. It covers issues specific to the elderly and the young, as well as providing practical tips for clinicians on how to improve their own cultural competence in the work setting. The book will be of interest to all mental health professionals and those involved in establishing health and social policy.
This book is a primer on Stepped Care 2.0. It is the first book in a series of three. This primer addresses the increased demand for mental health care by supporting stakeholders (help-seekers, providers, and policy-makers) to collaborate in enhancing care outcomes through work that is both more meaningful and sustainable. Our current mental health system is organized to offer highly intensive psychiatric and psychological care. While undoubtedly effective, demand far exceeds the supply for such specialized programming. Many people seeking to improve their mental health do not need psychiatric medication or sophisticated psychotherapy. A typical help seeker needs basic support. For knee pain, a nurse or physician might first recommend icing and resting the knee, working to achieve a healthy weight, and introducing low impact exercise before considering specialist care. Unfortunately, there is no parallel continuum of care for mental health and wellness. As a result, a person seeking the most basic support must line up and wait for the specialist along with those who may have very severe and/or complex needs. Why are there no lower intensity options? One reason is fear and stigma. A thorough assessment by a specialist is considered best practice. After all, what if we miss signs of suicide or potential harm to others? A reasonable question on the surface; however, the premise is flawed. First, the risk of suicide, or threat to others, for those already seeking care, is low. Second, our technical capacity to predict on these threats is virtually nil. Finally, assessment in our current culture of fear tends to focus more on the identification of deficits (as opposed to functional capacities), leading to over-prescription of expensive remedies and lost opportunities for autonomy and self-management. Despite little evidence linking assessment to treatment outcomes, and no evidence supporting our capacity to detect risk for harm, we persist with lengthy intake assessments and automatic specialist referrals that delay care. Before providers and policy makers can feel comfortable letting go of risk assessment, however, they need to understand the forces underlying the risk paradigm that dominates our society and restricts creative solutions for supporting those in need.