[Contributions and Challenges of Using Techno-Pedagogy to Support the Adoption of Best Practices in Mental Health]. / Contributions et défis de l'utilisation des technopédagogies à des fins de soutien à l'appropriation des meilleures pratiques en santé mentale.

Context Despite the considerable resources devoted and the efforts of the many actors involved, the gap between the production of scientific knowledge and its use in practice remains a challenge. The use of information and communication technologies (ICTs) is a valuable tool for reducing this gap. To address this challenge, a demonstration project focusing on the use of technology for knowledge translation was implemented with 23 community support teams in 5 regions of Quebec (2016-2018). More than 324 mental health professionals, team leaders and managers have benefited from the initiative "At your fingertips, best recovery-oriented practices." Objective This article presents the results of a satisfaction survey of team leaders responsible for clinical support in the community support teams under study. The purpose of this study is to enhance the understanding of issues identified during implementation and to make recommendations for the sustainable scaling up of the implemented knowledge translation program. Method A qualitative design in this evaluative research was adopted. At the end of the program implementation process, 2 group interviews were conducted with the team leaders. A content analysis following an inductive approach with 3 levels of coding was performed. Results The results show a significant digital gap within the Quebec health and social services network compared to other sectors of activity. Participants underlined the importance of adopting mechanisms for knowledge exchange and transfer that are integrated into organizational practices (dedicated time, formal clinical supervision, etc.) and which make use of ICTs. Conclusion Despite the significant technology upgrade required, the results suggest the relevance of using techno-pedagogy as the primary means of supporting knowledge translation and practice transformation. The tools developed and the support mechanisms explored appear to facilitate access to and adoption of best practices in mental health.

Service utilization by hospitalized suicide attempters with schizophrenia or depression in Montreal.

OBJECTIVE: The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. METHODS: This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). RESULTS: Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. CONCLUSIONS: The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.

[Portrait of the use of mental health services before and after a suicide attempt requiring hospitalization]. / Portrait du recours aux services de santé mentale avant et après une tentative de suicide qui requiert une hospitalisation.

Health care systems play an important role in suicide prevention. Medical and administrative data allow analysis of patterns of mental health service use before and after hospitalization following a suicide attempt among Montreal residents diagnosed with schizophrenia or depression. Some results tend to show improvement in suicide prevention, especially among men with comorbid substance abuse disorders known to be particularly vulnerable. However, other observations are somewhat worrisome. The emergency room as an introduction to mental health services did not ensure adequate aftercare. Interventions are needed to improve access and coordination between different health care services.

Suicide, schizophrenia, and schizoid-type psychosis: role of life events and childhood factors.

The first objective was to identify the provoking events of suicide in patients with schizophrenia or schizoid-type disorder, and to assess the humiliation component of these events. The second objective was to verify if quality of care during childhood is a vulnerability factor for suicide in patients with schizophrenia or schizoid-type psychosis. Thirty-three cases of suicide with a diagnosis of schizophrenia or schizoid-type psychosis were compared with 34 living patients with a similar diagnosis. The psychological autopsy method was used. The assessments were made with the Structured Clinical Interview for the Diagnostic and Statistical Manual for Axis I mental disorders, the Life Events and Difficulties Schedule, and the Child Experiences and Child Abuse Interview. The suicide group (SG) experienced more often a recent severe event, usually of a humiliation nature, than the control group (CG). It also experienced more severe events associated with aggressive behavior or with psychiatric impairment. Contrary to expectations, the CG had worse scores than the SG for quality of care during childhood. In conclusion, suicide in schizophrenia is related both to environmental stress and to psychiatric impairment.