Fifty years of public service for Quebec community psychiatry policies and services organisation
This essay comprises 2 parts. It aims to recognize the public service of psychiatrists of the Département de psychiatrie de l’Université de Montréal who served at the provincial level of the Ministry of Health and Social Services for deinstitutionalisation of policies and organisation of services, at the service of people with severe mental disorders. First with Dr. Camille Laurin post-face of the 1962 book Les fous crient au secours! (Mentally ill patients cry for help); then the insight on the latest phase of differentiated specialised clinics by Dr. Denis Lazure, who participated in 1962 to the Bédard, Lazure, Roberts commission that launched community psychiatry, but who will also be Social Affairs Minister in the late ‘70 s; Dr. Arthur Amyot will sail through the budgetary issues when in the beginning of the ’80s the mental health directorate was under Social Affairs; Dr. Luc Blanchet will be associated to a rich production of interdisciplinary reports by the advisory Mental Health Committee until its dismissal in 2003; and finally, Dr. André Delorme, who probably has the record of longevity at the head of the mental health directorate, transferred in 2003 under the deputy minister for medical and university affairs. The essay will propose since the beginning a grid or referential of four health services analysis. First; the arguments for community care by British and Italian psychiatrists and researchers, Thornicroft and Tansella. Second; system issues of mental health reforms proposed by Canadian psychiatric nurse and researcher Paula Goering. Third; the model of socio-political regulation of health system proposed by the Université de Montréal’ health administration researcher Dr. André-Pierre Contandriopoulos; and Fourth; the structural tension between the medical and social sector signaled by the American medical sociologist, Leutz. The same phases of deinstitutionalization in other countries as UK, took place as followed: a) the asylum phase (before 1960); b) the psychiatry community (1960-2000); and c) the differentiated system (since 2000). The essay will evidence the long march towards hospitals without walls, interdisciplinary work, tension between cure and rehabilitation and a relative decreasing budget. This in conjunction with vulnerability in organisation and leadership, attributed to tension or burn out has revealed system deficits like the trans-institution towards homelessness or towards the judiciary system. The essay will conclude with a discussion on the opportunities and challenges of the very new Law 10 that reforms the general governance of the provincial and regional health and social services and hopes for a more balanced mental health care system in Quebec.