Primary mental health care reform: catch the wave.

There is growing energy behind primary mental health care reform - from political activity, research, funding and clinical practice. The evidence that early adopters have been busy reforming mental health services in primary health care is apparent in the rise of references to primary mental health care and collaborative care in national and provincial planning documents, clinical trials examining the efficacy of collaborative mental health care, funded clinical programs across the country, and the establishment of a nationally funded initiative - the Canadian Collaborative Mental Health Initiative - to research and develop tools to implement collaborative mental health care. In conclusion, there is real momentum in primary mental health care reform. Health care planners and executives will want to turn their attention to collaborative care as the benefits to individuals and their families, the health care system, and to the economy are clear.

Maternal preoccupation and parenting as predictors of emotional and behavioral problems in children of women with breast cancer.

PURPOSE: To test the hypothesis that differences between sicker and not-so-sick women in their preoccupation with their illness and parenting behavior can explain why some investigators find that children of breast cancer patients fare better than controls and other investigators find the reverse. PATIENTS AND METHODS: Forty-two women with metastasized breast cancer (sicker mothers) and 45 women with a first occurrence of nonmetastasized breast cancer (not-so-sick mothers) rated the degree of their preoccupation with the disease, their parenting behavior, mood, and social supports and the emotional and behavioral symptoms in one of their children. Their 12- to 18-year-old children rated their mothers' parenting behavior, their own emotional and behavioral symptoms, and their self-esteem. RESULTS: Sicker mothers reported relatively less preoccupation. They, and their children, reported less poor parenting and fewer externalizing symptoms in the children. Regression analyses revealed further differences between the groups. CONCLUSION: Less preoccupation with their illness and less poor parenting behavior by sicker mothers may explain why their children seem to fare better then those of not-so-sick mothers. Formulations concerning families of breast cancer patients should include consideration of the effect of the mothers' perception of the severity of their illness.