The HIVE: a co-created art installation about health.

OBJECTIVES: We consider how artists explore complex health issues in a large-scale, collaborative art installation. STUDY DESIGN: This article describes - The HIVE - an arts-based knowledge translation (ABKT) initiative through which artists collaborated with researchers, service providers, health consumers, and carers affiliated with a major translational health research centre in Australia. METHODS: We present a case study that draws on artist statements and visual documentation to evoke the different facets of the initiative. RESULTS: The eight projects encompassed by The HIVE were diverse. Artistic media included textiles, sculpture, poetry and photography. Health issues ranged from palliative care to child healthcare. CONCLUSIONS: The HIVE was not simply an installation but a nucleus that fostered collaboration through the design and development of creative artworks. In emphasising empathy and non-verbal communication, The HIVE at once translated and expanded health(care) research and practice.

Mental health services for Nunavut children and youth: evaluating a telepsychiatry pilot project.

INTRODUCTION: This study examines the delivery of psychiatric consultation services using videoconferencing technology to health and mental health workers in the Nunavut territory of Canada. The research provides insights into the TeleLink Mental Health Program and the delivery of professional-to-professional program consultations and continuing education seminars. METHODS: Participant observation of 12 program consultations and four continuing education sessions was conducted. Individual interviews were conducted with the consulting psychiatrist and the lead program coordinator in Nunavut. As well, a focus group was held with Nunavut workers who participated in the televideo sessions. RESULTS: The study found a number of factors that facilitated or hindered the process and content of a consultation-based telepsychiatry program and its effect on building capacity among frontline staff. Four main themes emerged related to the delivery of psychiatric services via televideo: gaining access, ensuring culturally appropriate services, providing relevant continuing education, and offering stable and confidential technology. CONCLUSIONS: Live interactive videoconferencing technology is an innovative and effective way of delivering specialized mental health services to professionals working in remote areas of Nunavut. Study results provide important strategies for expanding this approach to other jurisdictions in Nunavut and other Inuit regions.

Social transformation, collective health and community-based arts: 'Buen Vivir' and Ecuador's social circus programme.

Worldwide, interest is increasing in community-based arts to promote social transformation. This study analyzes one such case. Ecuador's government, elected in 2006 after decades of neoliberalism, introduced Buen Vivir ('good living' derived from the Kichwan sumak kawsay), to guide development. Plans included launching a countrywide programme using circus arts as a sociocultural intervention for street-involved youth and other marginalised groups. To examine the complex ways by which such interventions intercede in 'ways of being' at the individual and collective level, we integrated qualitative and quantitative methods to document relationships between programme policies over a 5-year period and transformations in personal growth, social inclusion, social engagement and health-related lifestyles of social circus participants. We also conducted comparisons across programmes and with youth in other community arts. While programmes emphasising social, collective and inclusive pedagogy generated significantly better wellbeing outcomes, economic pressures led to prioritising productive skill-building and performing. Critiques of the government's operationalisation of Buen Vivir, including its ambitious technical goals and pragmatic economic compromising, were mirrored in social circus programmes. However, the programme seeded a grassroots social circus movement. Our study suggests that creative programmes introduced to promote social transformation can indeed contribute significantly to nurturing a culture of collective wellbeing.

Vulvodynia and psychological distress.

OBJECTIVE: To determine whether women with vulvodynia differ psychologically from women with other vulvar pathology and whether women with essential vulvodynia differ psychologically from women with vulvodynia in whom a cause has been identified. METHODS: Women attending a vulvar clinic were given a package consisting of the Brief Symptom Inventory, the Center for Epidemiologic Studies-Depression Scale, the Barsky Somatosensory Amplification Scale, the Whitely Index for hypochondriasis, and a study questionnaire. A gynecologist and dermatologist then took a careful history and performed a gynecologic examination, colposcopy, biopsies, and laboratory examinations. RESULTS: Vulvodynia patients (n = 50) were more symptomatic than women with other vulvar pathology (n = 32) on questions about interference with sexual function (mean difference 1.29, 95% confidence interval [CI] 0.36-2.23, P = .01) and number of doctor visits (mean difference 1.0, 95% CI 0.12-2.12, P = .03). Vulvodynia patients also scored higher than other vulvar patients on the Whitely Index (mean difference 0.45, 95% CI 0.04-0.86, P = .04) and on the Brief Symptom Inventory anxiety subscale (mean difference 0.31, 95% CI 0.09-0.51, P = .05) and somatization subscale (mean difference 0.29, 95% CI 0.10-0.46, P = .04). Women with essential vulvodynia (n = 32) were more anxious (mean difference 0.28, 95% CI 0.02-0.54, P = .02) and more suggestible (mean difference 0.62, 95% CI 0.48-1.72, P = .05) than women with vulvodynia with a physical cause (n = 18). CONCLUSIONS: Vulvodynia patients are more psychologically distressed than women with other vulvar pathology, and women with essential vulvodynia are more distressed than vulvodynia patients with an identified physical cause. Optimal management of vulvodynia patients should include attention to anxiety reduction, sexual function, normalization of every-day bodily sensations, reassurance about the absence of serious disease, and coordination of clinical care to ensure the maximum benefit from consultations.

Effects of client interviewers on client-reported satisfaction with mental health services.

A study at two outpatient facilities compared two methods of collecting data on client satisfaction with mental health services provided by case managers and by physicians. A satisfaction survey instrument was developed with input from clients. A total of 120 clients were randomly assigned to be interviewed by either a staff member or a client. Clients from both facilities reported high levels of satisfaction regardless of the type of interviewer. Clients gave a significantly greater number of extremely negative responses when they were interviewed by client interviewers. No difference between the two groups was found in overall satisfaction with services received from case managers or physicians.

Narratives of identity: re-presentation of self in people who are homeless.

The problem of homelessness is a pressing social and health concern ascribed to the interaction between personal, social, economic, and service system resources. The article is based on a qualitative study of the experiences of 29 homeless individuals. In-depth interviews were conducted with single adult shelter users. Analysis revealed the self to be a process that was continually developing. Participants tacitly locate their self-concepts in the past, present, and future. These time frames reflect the form and content of self. They also reveal hopes, dreams, beliefs, and understandings about self. The ways in which homelessness discredits notions of self and personal identity, and the hierarchy of identify with which homeless individuals use to cope are also examined.

What makes a house a home? An evaluation of a supported housing project for individuals with long-term psychiatric backgrounds.

Supported housing (as distinct from supportive housing) emphasizes the values of consumer choice; independence; participation; permanence; normalcy; and flexible, ongoing supports. As a model, it has only recently become popular in the literature and therefore little is known of its effectiveness in serving people with long-term psychiatric backgrounds. In 1989, Homeward Projects, a community mental health agency located in Metropolitan Toronto, established a supported housing project. Homeward included an evaluative component in its program from the outset. In order to give equal weight to the tenants' opinions, both quantitative and qualitative methodologies were employed. In the quantitative component, residential milieu, social support, and service delivery were examined. The qualitative component involved an ethnographic study which allowed the tenants to voice their experiences of living in such a setting. Results provided a rich understanding of the model. Overall, the tenants eventually came to describe their house as a home.

The experience of mental health consumers as researchers.

The purpose of this study was to examine the experiences of six mental health consumers who were involved in paid employment as researchers in the mental health field. Semi-structured interviews were conducted with these individuals in order to identify any benefits experienced as a result of their employment and to identify special needs that should be considered when employing consumers. Although consumers felt they had benefitted from their employment, several unmet needs were identified. The study findings support both the benefits experienced by mental health consumers who are employed as researchers and the necessity of providing meaningful opportunities for them to give feedback on their experience.

Response to Mitchell and Radford's rethinking research relationships in qualitative research: further thoughts and suggested training strategies.

This paper expands an important discussion initiated in an earlier publication of this journal (Mitchell & Radford, 1996). These authors point to a discrepancy between the ability of qualitative interviewers to elicit disclosures of personal information and the corresponding training of interviewers to respond appropriately to such disclosures. They suggest that high levels of disclosure may be attributable to the nature and duration of the qualitative research relationship. We propose that additional factors may be at play including, for example, the fact that research participants are sometimes paid for their participation. Based on our experience, we suggest strategies for training qualitative researchers.

Improving the income support of the chronically mentally ill: a model program to address the needs of the ex-psychiatric patient.

Interest in developing support services for the long-term mentally ill has increased in recent years. One of the most important aspects of support essential to the basic community survival of the chronic patient is income maintenance. Unfortunately, support in this area has been declining for this population. The purpose of this paper is to briefly outline the decline in the overall well-being of patients who rely on social assistance, describe a model income maintenance program established in a provincial psychiatric hospital, and, to evaluate the program's success in alleviating the financial problems of the long-term mentally ill. The income maintenance program described has proven to be a successful method of improving the economic situation of the long-term mentally ill. In its first 30 months of operation, the income status of over 3,000 patients has been systematically reviewed and 77% of those eligible have been converted to higher social assistance rates. The conversion has resulted in a 30 to 40% increase in income for the patients involved. The program has also contributed to improved relations with hospital staff and social assistance offices.

Psychologic distress during menopause: associations across the reproductive life cycle.

OBJECTIVE: To determine if women with high psychologic distress attending a menopause clinic report more previous psychiatric disorders (especially depression), or psychologic distress associated with oral contraceptive use and reproductive cycle events than women with low psychologic distress attending the clinic. METHOD: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI). Women with high psychologic distress (who met case severity on the BSI general severity index) were compared to a similar number of the lowest scoring clinic women on their reports of previous psychiatric diagnoses and treatment, and depression or distress related to oral contraceptive use, the premenstrual period, or associated with pregnancy. RESULTS: The forty-four women with high psychologic distress were significantly more likely than the forty-two menopause clinic patients with low psychologic distress to report a past psychiatric diagnosis (usually depression) (p = 0.001), requiring anti-depressant treatment (p = 0.002), oral contraceptive dysphoria (p = 0.004), dysphoric premenstrual syndrome (p = 0.000), postnatal blues (p = 0.02) and postpartum depression (p = 0.004). CONCLUSIONS: Although the halo effect of current distress or retrospective reporting may have biased these results, the similarity of ratings in the two groups on physical symptoms in menopause and psychologic symptoms during pregnancy makes this less likely. These findings corroborate other recent studies showing that women who suffer from affective disorders following one reproductive event are more vulnerable to recurrences associated with others. Clinicians should inquire about possible relationships between previous depression or psychologic distress and reproductive cycle events as it may help predict women who are vulnerable to affective disorders and psychological distress at these critical times.

Becoming and remaining homeless: a qualitative investigation.

This article reports the qualitative findings of a multimethod study of the homeless population in Toronto, Canada. The qualitative component sought to identify how people become homeless and why some individuals remain homeless for an extended period of time or cycle in and out of homelessness (the chronically homeless). In-depth, semistructured interviews were conducted with 29 homeless adults. The findings suggest that people both become and remain homeless due to a combination of macro level factors (poverty, lack of employment, low welfare wages, lack of affordable housing) and personal vulnerability (childhood abuse or neglect, mental health symptoms, impoverished support networks, substance abuse). Chronically homeless individuals often reported experiences of severe childhood trauma and tended to attribute their continued homelessness to a substance abuse problem. It is concluded that both macro and individual level factors must be considered in planning programs and services to address the issue of homelessness in Canada.

Early rehospitalization.

The process and outcome of discharge planning were examined at a large provincial psychiatric hospital. Two hundred patients were studied to determine whether or not they received services from the agencies to which they were referred after discharge. In addition, patients who were rehospitalized within three months of discharge were identified in order to determine whether they differed from the rest of the cohort. Eighty-three percent of the patients for whom referrals were made sought help from at least one aftercare service or community agency, suggesting that there is considerably more aftercare in the community than has previously been documented. The implications of these findings for treatment, research and policy planning are discussed.

What makes women tired? A community sample.

We aimed to determine the major health concerns or problems of women and their personal attributions for the causes of their primary health concerns. We used a survey of women from the Toronto area attending a women's health symposium. Completed questionnaires were returned by 153 (85%) of 180 women attendees. Persistent fatigue was the primary and most commonly cited health concern. Fatigue was ranked first by 42 (27.5%) women and among the top 10 concerns by 123 (80.4%) women. Women attributed their fatigue to a combination of home and outside work (63.4%), poor sleep (38.2%), lack of time for self (34.1%), lack of exercise (32.5%), financial worries (28.5%), relationship problems (22.0%), emotional causes (17.9%), care of ill family members (13.8%), lack of social or individual support (9.8%), poor physical health (8.9%), work in home or child care (3.3%), or gender bias/harassment (2.4%). Our subjects, women from the community, overwhelmingly endorsed social determinants as the cause of their persistent fatigue. Although depression and anxiety form the most robust associations with persistent fatigue in primary care and community studies, women in this sample ranked these factors in seventh place in their attributions. Similarly, although physicians often assume physical causes for fatigue, women rank physical health low in their own attributions. Given the high prevalence of fatigue in women and its impact on quality of life, more attention needs to be given to the social, systemic, and personal factors that women feel contribute to their fatigue to develop more effective interventions.

A prospective study of the effectiveness of brief professionally-led support groups for infertility patients.

OBJECTIVE: This study prospectively evaluates the effectiveness and patient acceptability of professionally-led support groups in alleviating psychologic distress in infertility patients. METHOD: Sixty-four consecutive patients in a university hospital infertility program were administered a battery of psychologic tests before and after attendance at an 8 weekly session support group. The comparison group consisted of 35 consecutive infertility referrals to the same unit who were not initially offered the support group and were similarly tested over an 8 week period. RESULTS: Support group patients had significantly greater (p less than or equal to 0.01) entry than exit scores on several measures of psychologic distress and depression (the Beck Depression Inventory, the Hamilton Rating Scale for Depression, and the Global Severity Index, Anxiety, Depression, Hostility and Obsessive Compulsive Subscales of the Brief Symptom Inventory). The Avoidance Coping Style on the Moos Coping Responses Inventory was correlated with a higher Global Severity Index (p less than or equal to 0.01). Comparison group patients had similar psychometric scores to the support group patients at entry but showed no change over 8 weeks. Attenders expressed a high rate of satisfaction with the support group. CONCLUSIONS: Professionally-led support groups are a highly acceptable and effective intervention in self-referred patients in alleviating psychological distress related to infertility.

Housing for people with mental illnesses: a comparison of models and an examination of the growth of alternative housing in Canada.

The decrease over the past three decades in institutional care for people with mental illness has not been matched by the adequate development of specialized housing in the community. Broadly speaking, two major models of housing have emerged in the past 30 years: custodial and alternative. Large custodial settings, including boarding houses, nursing homes and special care homes, are typically not associated with residents' satisfaction or a positive outcome. Alternative housing refers to a range of models, including halfway houses, group homes, co-ops and supported housing. It is associated with better residents' outcomes. This paper briefly compares the two models and examines key issues in alternative housing and its development in Canada.