La Cité de la santé, une expérience d'empowerment

International audienceThe Cité de la santé (City of Health), an information and resource centre based in Paris's largest science museum, the Cité des sciences et de l'industrie, provides the general public - whether they be users, carers, professionals or simple passersby - with access to a wide variety of interactive information sources allowing individuals to empower themselves to become actors of both their own personal health and the health of their community. Situated at the heart of a cultural mediation space including representatives of user, carer and professional organisations, the Cité de la santé has become a veritable reference point in France for developing and valorising healthcare service user expertise through exhibitions, events and workshops in a wide variety of health areas.Centre de ressources documentaires, lieu d'accueil et de service, la Cité de la santé s'inscrit dans l'offre de médiation de la Cité des sciences et de l'industrie. Cette plateforme partenariale donne à l'usager - qu'il soit malade, proche de malade, professionnel ou simple curieux d'une question de santé - les moyens de s'informer librement pour devenir citoyen éclairé et acteur de sa propre santé. De plus, située au sein d'un établissement culturel et médiatrice entre les personnes, les représentants des malades et les soignants, la Cité de la santé est devenue un cadre de référence pour la construction et la reconnaissance de l'expérience des patients, comme le confirment les expositions et témoignages ou les journées de dialogue qu'elle coproduit

The Time of the Infant, Parent-Infant Desynchronization and Attachment Disorganization, or How Long Does it Take for a Preventive Action to be Effective?

The classical version of early development by psychoanalysis has been largely challenged by developmental psychology, and particularly by attachment theory. Psychopathology appears to be much more linked with a sequence of events involving interpersonal relationship disorders rather than with intra psychic conflicts, as hypothesised by drive theory. Establishing synchrony between parent and infant is probably one of the major tasks of the first year of life. Attachment theory appears to be the modern paradigm to understand how the several types of answers from caregivers to stressing situations in the infant give way to different emotional and cognitive regulatory strategies, with impact on the effectiveness of the stress buffer systems. This paper presents what we can figure out about what is time to the infant, the importance of synchronization within infant and caregiver, the key concept of attachment disorganization, the concept of sustained social withdrawal as a defence mechanism and an alarm signal when synchronisation fails, and finally the key issue of conditions for effectiveness of early parent- infant preventive intervention.Parent- infant synchrony, Attachment Disorganization, Parenting, infant social withdrawal behaviour, early prevention and intervention

Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life

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Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial.

International audienceBACKGROUND: Recent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France.Method and design: A prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a 'high' level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score <= 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included. DISCUSSION: This is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context.Trial registration: The current clinical trial number is NCT01570712

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

This research was financially supported by DG-Sanco (contract: 800197; 2007-2010). The authors would like to thank all of the professionals and services who participated in the PROMO assessment of services. A PhD grant from Fundação para a Ciência e Tecnologia–Portugal (SFRH/BD/66388/2009) to the first author is acknowledged

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

Abstract Background: Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p

Facilitators and obstacles in access to work for people with mental illness

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