[Evaluating the implementation of involuntary hospitalization procedures: a profile of people, audits and recommendations]. / Évaluation de l'implantation d'un nouveau protocole de garde en établissement: profil de la clientèle, audit de dossiers et recommandations.

Since the 1990s, legislative reforms have been undertaken in many Western countries to reduce involuntary hospitalization. Studies examining fluctuation rates before and after the legislative reform show a general trend toward an increase rather than a decrease in involuntary hospitalization rates (de Stefano & Ducci, 2008). In Quebec, many reports have shown that consent for psychiatric evaluation and hospitalisation for people who present an imminent danger to themselves or to others is difficult to obtain due to clinical, legal, and ethical considerations. To facilitate this process, a new protocol was developed and implemented following the training of 335 health workers and 85 medical doctors in 6 hospitals. Our study evaluated this protocol and established a profile of people who had been hospitalized against their will. Using a retrospective analysis, we examined the files of 179 patients who underwent a psychiatric evaluation process during an involuntary hospitalization. This file analysis allowed us to develop a better profile of these people and determine whether the required forms were present and how adequately they were filled out by the professionals. We also conducted a study with the professionals responsible for applying the new protocol to get a better idea of its characteristics (relative advantage, compatibility, simplicity, reversibility and observability) as well as the principles of consent and the obstacles to its implementation.Our study showed that that half of the patients were diagnosed with schizophrenia or another psychosis. Fifty-four point two percent (54.2%) of the patients were males, 79% were single or separated and only 18,4% were working. At the time of their crisis situation, 30,7% were brought to the hospital by police officers and 19% were already hospitalized. The remaining patients were brought in by ambulance, family members or they came in by themselves. Professional opinion of the new protocol was positive however they did not rigorously enter the data required in the new forms. The new form was present in only 51% of files and when consent was given, it was only documented in 27% of the cases.These results highlight the need to improve the documentation process given in the protocol. It would be very useful to establish strategies to obtain this consent in light of the specific characteristics that make up this subgroup of people who have been hospitalized against their will. Legislation alone is not enough to invoke a change in the involuntary hospitalisation rate. The clinical and organisational context must also be actively prepared to receive this new practice. In order to do this, evaluative research could contribute to improving the level of implementation and be of benefit to people in crisis and those with mental disorders.

[Are mental health disorders' characteristics such as presence and severity related to the nature of a crisis, its dangerousness and the types of services offered?]. / La présence et la gravité des troubles de santé mentale sont-elles liées à la nature de la crise, à la dangerosité et aux services de crise offerts ?

UNLABELLED: The mandate of crisis centres varies substantially from one country to the next according to the government policies in effect. In the United States, crisis centres were developed based on Caplan's theory, which defines crisis as a psychosocial disorganization following a life event that is resolved with a return to balance. This approach aims at preventing the onset of mental health disorders through short-term intervention. It is different in Quebec, where crisis centres were developed in a deinstitutionalization context and ought to constitute an alternative to hospitalisation. Such mandate of Quebec crisis centres is not necessarily of the preventive nature associated with Caplan's theory and it has led to services having to be adapted to a heterogeneous clientele that may or may not suffer from mental health problems. It has implications related to the crisis characteristics such as its nature, intensity, and dangerosity, as well as implications regarding the organization of crisis centre services, which have been the object of few studies so far. OBJECTIVE: The present study aims at distinguishing clinical profiles of crisis centre callers according to the presence or absence of a mental health disorder and its nature, that is severe and persistent (psychotic or bipolar disorder) or not (mood, anxiety or personality disorder). In order to do so, participants are compared on the characteristics of the crisis and the services they received. METHOD: In this descriptive study, the files of 1170 new assistance applicants are retrospectively analyzed based on a predetermined grid that was used to collect data according to the main clinical characteristics of persons in distress, as recognized in the literature. The subgroup of persons presenting a psychotic or bipolar disorder was examined separately from the one comprising persons with an anxiety, mood or personality disorder because of its clinical complexity, which generally requires intensive, multidisciplinary follow-up. RESULTS: Among the new applicants, 48% had a mental health disorder and, of these, 9% reported a serious mental health disorder, that is, a psychotic or bipolar disorder. The results indicate that having an anxiety-, mood- or personality-type disorder is associated with a higher probability of reporting stressful interpersonal-type events, a more intense crisis, as well as a greater risk of auto-aggressive behaviours. Meanwhile, persons with a psychotic or bipolar disorder are more frequently provided with accommodations and more likely to receive intensive and support services, such as emergency interventions or the use of the Act respecting the protection of persons whose mental state presents a danger to themselves or others (P-38). CONCLUSIONS: This descriptive portrait of the crisis centre clientele contributes to the reflection on differential intervention with persons in a crisis situation. It appears important to take an interest in the presence and type of mental health disorders of crisis centre callers, since these characteristics help to better foresee not only the nature and intensity of the crisis but also the type of services required. However, Quebec crisis centres have to respond to the needs of a heterogeneous clientele without having access to a typology and a theoretical model that consider this clinical diversity. Other studies should be conducted to validate, on the one hand, a crisis typology that would make it easier for caseworkers to collect data for evaluation purposes and, on the other hand, a differential intervention model.

La innovación psicosocial: planificar su implementación y difusión para prevenir la delincuencia juvenil / The Psychosocial Innovation: Planification of Implementation and Dissemination to Prevent Juvenile Delinquency

La innovación en la prevención de la delincuencia juvenil orienta sus acciones hacia el mejoramiento de la calidad de los ambientes sociales. Eso significa que las personas que interactúan en la vida cotidiana con los niños y adolescentes en dificultad en sus medios naturales (familia, escuela, barrio) se transforman en los grupos objetivo para participar en programas preventivos. Este enfoque recibe un sólido fundamento científico, pero su aplicación concreta está a menudo limitada debido a problemas en la difusión de la innovación psicosocial. Podemos fácilmente imaginar los obstáculos que puede haber para establecer un sistema eficaz de comunicación entre los diferentes grupos involucrados (investigadores, tomadores de decisión, agentes de intervención y miembros de la comunidad). Es importante reflexionar sobre este problema ya que la dificultad de difundir las nuevas prácticas en terreno puede poner en riesgo los efectos benéficos esperados. El presente texto tiene por objetivo el proponer un marco integrador orientado a optimizar el paso entre los universos científico, político y práctico apoyándose en la teoría de la difusión de la innovación.

Evidence-based psychosocial treatments for the prevention of juvenile delinquency emphasize the importance of a high quality social environment. However the promotion of this approach in real life is somewhat hindered by diffusion-related problems associated with psychosocial innovation. Indeed, communication between researchers, policy makers, clinicians and members of the community is not an easy task. The communication gap between research and practice is an important issue because its failure could compromise the impact of the intervention on youths at risk of juvenile delinquency. The objective of this article is to put forth a conceptual framework based on theory of diffusion of innovation specifically geared towards optimizing the cohesion between the scientific, politic and practice worlds.