Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review.

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Embodying or resisting social normativity? A carnal inquiry into exercise addiction experiences.

Exercise addiction has sparked a growing interest in the scientific and clinical literature, yet this behavioral addiction has mainly been investigated quantitatively, from a positivistic perspective. This article explores the subjective and embodied dimensions of exercise addiction, broadening current conceptions of this emerging, still unofficial mental health category. Building on carnal sociology, and through a thematic analysis of mobile interviews conducted with 17 self-proclaimed "exercise addicts" from Canada, this article examines the interrelations between the embodiment of exercise addiction and the normative social elements at stake in the shaping of the category, providing insights on how exercise is experienced as an addiction. Results show that most participants describe this addiction as "soft" and "positive", highlighting the virtues of exercising. However, their bodily accounts also reveal a suffering body, bringing forth the vices related to excessive exercising. Participants also put in relation the quantifiable and the sensible body, revealing the porous boundaries of this construct: exercise addiction can sometimes be regulatory in certain contexts and counternormative in others. Thus, it appears that "exercise addicts" enact various contemporary normative requirements, which vary from asceticism and body-ideals but also to the phenomenon of social and temporal acceleration. We argue that exercise addiction questions how certain behaviors, deemed potentially problematic, illustrate the tensions and complex articulations between embodying and resisting social normativity.

Assessing Virtual Mental Health Access for Refugees during the COVID-19 Pandemic Using the Levesque Client-Centered Framework: What Have We Learned and How Will We Plan for the Future?

During the COVID-19 pandemic, mental health services rapidly transitioned to virtual care. Although such services can improve access for underserved populations, they may also present unique challenges, especially for refugee newcomers. This study examined the multidimensional nature of access to virtual mental health (VMH) care for refugee newcomers during the COVID-19 pandemic, using Levesque et al.'s Client-Centered Framework for Assessing Access to Health Care. One hundred and eight structured and semi structured interviews were conducted in four Canadian provinces (8 community leaders, 37 newcomer clients, 63 mental health or service providers or managers). Deductive qualitative analysis, based on the Client-Centered Framework, identified several overarching themes: challenges due to the cost and complexity of using technology; comfort for VMH outside clinical settings; sustainability post-COVID-19; and communication and the therapeutic alliance. Mental health organizations, community organizations, and service providers can improve access to (virtual) mental health care for refugee newcomers by addressing cultural and structural barriers, tailoring services, and offering choice and flexibility to newcomers.

Pandémie et communautés minoritaires marginalisées : vers une approche inclusive en santé publique?

The pandemic has highlighted the complexity of public health measures and their side effects, the intricacy of the underlying health, social and political phenomena at play as well as their specificity for marginalized minority communities. Based on this experience, this commentary suggests that it would be relevant in the future to develop consultation mechanisms that take into account the entire population, including marginalized minority groups, in order to better inform decision-making processes in times of pandemic. In a context of fluid crisis, any consultation process must take into account the limits of what is possible and mourn the comprehensiveness in favour of repeated iterations of dialogue, mediation and decision-making. This means creating conditions favourable to the consideration of the most vulnerable people and groups' voices by public authorities. In order to prepare for the next crises, it is necessary to develop strong links between public institutions and communities, both of majorities and minorities, in order to define the mechanisms favouring the emergence of truly inclusive public health, taking into account the physical, mental and social health of the population.

RéSUMé: La pandémie a mis en lumière la complexité des mesures de santé publique et de leurs effets collatéraux, l'intrication des phénomènes sanitaires, sociaux et politiques sous-jacents, ainsi que leur spécificité pour des communautés minoritaires marginalisées. Fort de cette expérience, le présent commentaire souligne la pertinence d'élaborer des mécanismes de consultation qui tiennent compte de l'ensemble de la population en incluant les groupes minoritaires marginalisés, pour mieux informer les processus décisionnels en temps de pandémie. Dans un contexte de crise fluide, tout processus de consultation doit tenir compte des limites du possible et faire le deuil de l'exhaustivité au profit d'itérations répétées de dialogue, de médiation et de prises de décision au sujet de l'action. Il s'agit de créer des conditions propices à ce que les voix des personnes et groupes plus vulnérables soient entendus par les autorités publiques. Afin de nous préparer aux prochaines crises, il est nécessaire d'ores et déjà de développer des liens forts entre institutions publiques et communautés, tant majoritaires que minoritaires, afin de définir les mécanismes favorisant l'émergence d'une santé publique réellement inclusive, qui tienne compte de la santé physique, mentale et sociale de la population.

[Migrant Families' Engagement in Youth Mental Health Collaborative Care: Clinical Spaces Anchored within their Institutional and Sociopolitical Context]. / L'engagement dans les soins en collaboration en santé mentale jeunesse pour les familles migrantes : des lieux cliniques ancrés dans leurs contextes institutionnel et sociopolitique.

Objective This article aims at filling some gaps in the literature regarding conditions conducive to high-quality collaborative care in youth mental health (YMH) for migrant families. It focuses on the factors that are susceptible to foster the engagement of migrant families in the services, by examining the clinical encounter, as well as sociopolitical and institutional dimensions. Methods Using a multiphase mixed methods design, it sequentially follows qualitative and quantitative results regarding migrant families within the different projects of a research program on collaborative care in YMH in culturally and socioeconomically diverse neighborhoods, done in Montreal during the last decade. These results come from data collected through questionnaires, semi-structured interviews, focus groups, participatory observation and documentation, with research participants being children, adolescents and parents from migrant families, clinicians and managers. Results The results suggest that the sociopolitical and macro institutional system finds its way into the clinical space by influencing the process of care. In particular, successive reforms of the health system challenge institutions and YMH teams in their capacity to create a favourable environment for continuity of care and interinstitutional partnership and interprofessional collaboration, factors associated with families' engagement into care. This engagement is also dependent on the representations of mental health and services that migrant families hold. These representations are shaped by their experience of the services, but also by what their sociocultural environment and the public discourses allow them to imagine of these services. This calls for the integration of cultural and sociopolitical dimensions within the concept of engagement. Finally, results also suggest that schools are playing an important role to foster engagement in mental health care. Conclusion The quality of mental health care for migrant children and adolescent relies on the engagement of families, as well as on the mutual engagement of clinicians and of their institutions. Political contexts where tensions between majority and minority groups are present can also act as barriers to the care. Given that migrant families are engaging less in the services compared to non-migrant families, these considerations call for an important review of avenues to facilitate engagement of migrant families into collaborative care YMH services. This article suggests certain avenues to promote this engagement.

Hurtful Gifts? Trauma and Growth Transmission Among Local Clinicians in Postearthquake Haiti.

Although working with trauma survivors can be a source of both deleterious and positive transformations in mental health professionals, little is known about the experience of clinicians in shared traumatic contexts, particularly in the Global South, where most humanitarian crises occur. In collective disasters or armed conflicts, the personal and professional experiences of mental health staff inform each other, situating the clinical space at the intersection between singular and collective spheres. Drawing on an intersubjective and socioecological perspective, this qualitative study explored the ways in which working in a shared traumatic context affected mental health and psychosocial staff in postearthquake Haiti. We interviewed 22 local mental health workers in the capital, Port-au-Prince, 2.5 years after the 2010 disaster. We coded and thematically analyzed interviews using an iterative process, based on grounded theory principles. Thematic analysis uncovered four dynamic poles in clinicians' narratives: balancing duty and desire to help, experiencing fragility and strength, negotiating separation and connection, and sharing hurt and hope. Our findings suggest clinicians considered their work mainly as a source of strength in the face of adversity, whereas experiences of trauma and growth transmissions were mutual and intimately intertwined. We discuss the complexities of clinical work in shared traumatic settings as well as the dynamic interplay between professionals' experiences of suffering and growth. We conclude with recommendations on ways to involve local mental health clinicians in postdisaster contexts while addressing the special needs that they may have to process their own trauma.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) ¿Regalos Hirientes? trauma y transmisión del crecimiento entre clínicos locales en Haití Post-Terremoto TRAUMA Y TRANSMISIÓN DEL CRECIMIENTO EN HAITÍ Aunque trabajar con sobrevivientes a trauma puede ser una fuente de transformaciones deletéreas y positivas en los profesionales de salud mental, se conoce poco acerca de la experiencia de clínicos en contextos traumáticos compartidos, particularmente en el Sur Global, donde ocurre la mayoría de las crisis humanitarias. En desastres colectivos o conflictos armados, las experiencias personales y profesionales del personal de salud mental se influyen mutuamente situando el espacio clínico en la intersección entre las esferas colectiva e individual. Utilizando una perspectiva intersubjetiva y socioecológica, este estudio cualitativo exploró las formas en que el trabajar en un contexto compartido traumático afectó al personal de salud mental y psicosocial (MHPSS, por su sigla en inglés) en Haití post-terremoto. Entrevistamos a 22 trabajadores de salud mental locales en la capital, Puerto Príncipe, 2.5 años después del desastre de 2010. Codificamos y analizamos temáticamente las entrevistas usando un proceso iterativo, basado en teoría fundamentada. Los análisis temáticos descubrieron cuatro polos dinámicos en las narrativas de los clínicos: equilibrando deber y deseo de ayudar, experimentando fragilidad y fuerza, negociando separación y conexión, y compartiendo daño y esperanza. Nuestros hallazgos sugieren que los clínicos consideraban su trabajo principalmente como una fuente de fuerza ante la adversidad, mientras que las experencias de trauma y transmisión de crecimiento fueron mutuos e intimamente entrelazados. Discutimos las complejidades del trabajo clínico en escenarios traumáticos compartidos así como también la interacción dinámica entre las experiencias de sufrimiento y crecimiento de los profesionales. Concluimos con recomendaciones en formas para involucrar a los clínicos de salud mental locales en contextos post-desastre mientras se abordan las necesidades especiales que puedan tener para procesar su propio trauma.

Perspectives of Migrant Youth, Parents and Clinicians on Community-Based Mental Health Services: Negotiating Safe Pathways.

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12-15 years old), one of their parents and their primary care therapist (N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

Current Trends in Theoretical Orientation of Psychologists: The Case of Quebec Clinicians.

OBJECTIVE: Trends indicate that clinical psychologists' theoretical orientations have changed over the last decades in North America, but research on this topic in Canada is scarce. We analyzed the orientation of psychologists over the last 20 years in the province of Quebec, where 46% of Canadian psychologists are located. METHOD: Data were collected annually through the board registration form of Quebec psychologists' professional order from 1993 to 2013. Univariate statistical analyses were realized on aggregated data. RESULTS: In 20 years, the proportion of clinicians choosing cognitive-behavioral therapy (CBT) as their main orientation grew from 18.4% to 38%, while preference for other orientations slightly declined. Existential-humanistic and psychodynamic-psychoanalytic approaches remained the primary orientation for around 21.7% and 21.5%, respectively. In 2013 (N = 8608), when taking into account 2 choices of theoretical orientation, 55.8% of clinicians chose CBT, 34.3% existential-humanistic orientation, 27.9% psychodynamic-analytic theories, and 21.8% systemic-interactional orientation. CONCLUSIONS: Findings underline trends in Quebec clinical practice characterized by an increase in the number of psychologists identifying cognitive-behavioral approach as their primary self-reported theoretical orientation.

A vacation for the homeless: evaluating a collaborative community respite programme in Canada through clients' perspectives.

This study assesses the Urban Breakaway Project, a collaborative project offering a structured vacation in the countryside of the province of Quebec intended for homeless (or street) youths. The objective of this study was to document participants' perspectives regarding this project by examining their satisfaction, intention to change following their stay and perceived improvement with respect to their life situation. Another goal of this research was to investigate the relationship between satisfaction level and perceived improvement of participants. One hundred and seven individuals participated in the study, during Urban Breakaway's first year of operation. Satisfaction with the project, assessed with the global Client Satisfaction Questionnaire-3 score, revealed a positive relationship with global scores of perceived improvement, as measured by the Perceived Improvement Questionnaire [PIQ; r = 0.37 (67), 95% CI (0.15; 0.56)]. Regarding intention to change, the data indicated that 95% of participants had moderate-to-definite intentions to do something to change their lives. Participants reported an improvement for most items covered by the PIQ. They experienced the greatest changes in relation to mood, leisure, appetite, physical condition and self-esteem. Results indicate that the Urban Breakaway Project reaches not only street youths but also an older homeless population. Participants, regardless of their age, were found to be very satisfied with services obtained, and their satisfaction was significantly correlated with the perceived improvement in their situation. Qualitative data indicate that characteristics of the programme, such as the countryside setting, the focus on basic needs, the climate and the opportunity for socialisation, peer support (or belonging) and personal growth were appreciated.

Partnership at the forefront of change: documenting the transformation of child and youth mental health services in quebec.

OBJECTIVE: The Quebec Plan d'action en santé mentale (PASM) (Mental Health Action Plan) reform, a major transformation of the province's mental health care system, has put primary care rather than hospital-based care at the forefront of mental health service delivery. This study documents perceptions of changes in child and youth mental health (CYMH) services following the reform, as well as facilitators and obstacles to collaboration and partnership in CYMH services, and the specific challenges related to collaboration and partnership when servicing multi-ethnic populations. METHODS: This qualitative participatory research study collected data using semi-structured individual interviews, focus groups and participant observation in community-based health and social service institutions. Thematic analysis was performed. RESULTS: The reform process encountered challenges in building a common culture of care within and between institutions, while collaboration and partnership evolved in a positive direction throughout the study. Study results highlighted the importance of fostering communication at all levels. Collaboration and partnership was facilitated by opportunities for clinical discussions, dialogue on models of care, harmonizing administrative and clinical priorities, and involving key actors and structures. The results revealed difficulties in implementing multidisciplinary work and in negotiating partners' responsibilities. Quality of partnership and collaboration appeared particularly crucial in providing optimal care to vulnerable families, including migrants. CONCLUSION: The PASM reform involved a major and challenging transformation in CYMH services. Continuous dialogue through time and leadership sharing appeared promising to foster this transformation.

[Culture and mental health in Haiti : a literature review]. / Culture et santé mentale en Haïti : une revue de littérature.

This paper reviews and summarizes the available literature on Haitian mental health and mental health services. This review was conducted in light of the Haitian earthquake in January 2010. We searched Medline, Google Scholar and other available databases to gather scholarly literature relevant to mental health in Haiti. This was supplemented by consultation of key books and grey literature relevant to Haiti. The first part of the review describes historical, economic, sociological and anthropological factors essential to a basic understanding of Haiti and its people. This includes discussion of demography, family structure, Haitian economics and religion. The second part of the review focuses on mental health and mental health services. This includes a review of factors such as basic epidemiology of mental illness, common beliefs about mental illness, explanatory models, idioms of distress, help-seeking behavior, configuration of mental health services and the relationship between religion and mental health.

Haïti-Québec-Canada: vers un partenariat en santé mentale

Les 24 et 25 avril 2008 se tenait à Montréal le colloque «Haïti-Québec-Canada : Vers un partenariat en santé mentale 1 ». Ce résumé des présentations et discussions du colloque esquisse les questions soulevées par les panélistes venus dÆHaïti et du Québec. La première section relate lÆhistoire de la psychiatrie et lÆinfluence de la culture sur la santé mentale en Haïti ; la seconde section montre les problèmes de violence et de trauma ; la troisième partie étudie les problématiques spécifiques aux femmes, aux enfants et aux jeunes ; la dernière partie résume les conférences centrées sur les initiatives innovatrices, et sur les pistes dÆexploration pour une politique de santé mentale en Haïti.

[Mental Health courts: therapeutic jurisprudence in action]. / Les Tribunaux de santé mentale : déjudiciarisation et jurisprudence thérapeutique.

In Québec, as elsewhere in North America, psychiatric deinstitutionalization, lack of community mental health resources as well as legislative changes to civil and criminal codes have led to an increased probability that individuals with a mental illness come into contact with the criminal justice system. Based on the principle of therapeutic jurisprudence, mental health courts constitute emerging diversion programs, taking place within the court, implemented to offer an alternative to incarceration for individuals with a mental illness. This article offers a critical synthesis of the scientific literature on the topic. The authors first present the context in which mental health courts were developed ; describe their objectives and functioning ; and introduce the Montreal Mental Health Court pilot project, renamed PAJ-SM (Plan d'Accompagnement Justice et Santé) the first of its kind in Québec. The paper examines the research on mental health courts and tackles some of the stakes of diversion programs. The challenges and limits inherent to specialized courts are discussed as well as methodological obstacles related to the study of these complex intervention programs. The authors conclude that mental health courts offer promising intervention venues, but that they do not constitute a panacea to resolving all issues related to the contact of mentally ill individuals with the justice system. Mental health courts must be accompanied by other intervention strategies for persons with mental health problems at all stages of the criminal justice process.