«Est-ce possible d’offrir des services innovateurs en psychiatrie? Le cas Jean-Talon»

Quelque dix ans après la sectorisation et l’apparition du communautaire en psychiatrie, une rétrospective critique s’impose. Jean-Talon, symbole mythique à résonnances diverses au cœur du réseau psychiatrique, veut prendre sa place dans cet important débat. Mais en fait, ce n’est plus Jean-Talon : ce sont trois travailleurs psychologues qui veulent témoigner de leur expérience à Jean-Talon, en espérant que ce témoignage servira à d’autres intervenants dans leurs efforts pour critiquer et renouveler leur pratique. Ce sera donc un regard sur le passé, une sorte de requiem qui sonne le glas de nos rêves, battus en brèche entre autres par le pouvoir médical et administratif. Nous nous situons évidemment à l’intérieur du système psychiatrique, même si nous doutons que la réponse psychiatrique soit la réponse la plus adéquate à la folie. Il ne nous reste plus qu’à prendre le seul pouvoir qu’il nous reste, soit celui de la parole, pour faire part de nos questions et de nos réflexions. C’est une parole répétitive mais nécessaire qui veut rendre compte de notre désir de changer l’écoute et la réponse à la souffrance: en somme, ce changement est-il possible ? Si oui, à quelles conditions ?The authors describe their experience at the Jean-Talon Hospital. In 1975 a department of psychiatry was created according to a new model. After describing the vicissitudes of the project, the achievements and failures, the authors analyse the reasons for the failure. There are several reasons : the medical and administrative powers who refuse change, and the members of the team who do not feel prepared to assume the power

A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region

<p>Abstract</p> <p>Background</p> <p>Identification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors.</p> <p>Results</p> <p>Using this set of geographical units shows important socioeconomic and health disparities at the local scale. These disparities can be seen, for example, in a 16-year difference in disability-free life expectancy at birth, and a $10,000-difference in average personal income between close neighbourhoods. The geographical units also facilitate information transfer to local stakeholders.</p> <p>Conclusion</p> <p>The context of this study has made it possible to explore several relevant methodological issues related to the definition of neighbourhood units. This multi-perspective approach allows the combination of many different elements such as physical structures, historical and administrative boundaries, material and social deprivation of the population, and sense of belonging. Results made sense to local stakeholders and helped them to raise important issues to improve future developments.</p