information and support guide - irdpq...2 information and support guide intended mainly for families...

InformatIon and support guIdefor families and friends of individuals with mental health problems

ACKNOWLEDGEMENTSWe would like to thank the following people who, on top of their day-to-day work, have generously contributed their time to planning and writing this guide for families and friends of individuals with mental health problems.

WRITING • Andrée Samson, Member, Cercle Polaire• Ève Lachance, Coordinator, Cercle Polaire• Hélène Fradet, Director, FFAPAMM• Karl Johnson, Planning, Programming, and Research Officer,

Institut universitaire en santé mentale de Québec• Louise Drolet, Member, La Boussole• Louise Latulippe, Research and Socio-economic Planning Officer,

Direction de la santé mentale, MSSS• Marie Péloquin, Social Worker, CHUQ• Monique Thibault, Nurse, CHUQ• Renée La Haye, Member, La Boussole• Sylvie Vaillancourt, Coordinator, programme-clientèle de psychiatrie, CHA

EDITING• Madeleine Fex, Language Editor• Gene Bourgeau, Translator

COLLABORATIONCercle Polaire• André-Gaétan Corneau, Member, Cercle Polaire

Institut universitaire en santé mentale de Québec• Anne Thibault, Chief, Archives department• Claire Ludanyi, Clinical Nurse• Dominique Harvey, Clinical Nursing Counsellor• François Chassé, Planning, Programming, and Research Officer• Isabelle Fillion, Social Worker• Danielle Fortier, Information Officer• Josiane Lavallée, Social Worker• Langis Lemieux, Coordinator, Service Programming and Evaluation• Mélissa Boily, Planning, Programming, and Research Officer• Nicole Gagnon, Local Commissioner, Complaints and Service Quality• Patricia Laflèche, Planning, Programming, and Research Officer• Noémie Trottier, Planning, Programming, and Research Officer

I

TABLE OF CONTENTS

PREAMBLE 1

BACKGROUND 3

1. ORGANIZATIONOFSERVICES 5

1.1 OrganizationofmentalhealthcareandservicesinQuébec 5

1.1.1 Primarycareservices 51.1.2 Secondarycareservices 51.1.3 Tertiarycareservices 5

1.2 CSSS(CLSCmission) 61.2.1 Ifyourfamilymemberorfriend

hasafamilyphysician 61.2.2 Ifyourfamilymemberorfriend

doesnothaveafamilyphysician 61.2.3 Ineithersituation 6

1.3 Hospitalemergencyservices 7

1.4 Whenafamilymemberorfriendishospitalized 91.4.1 Howdoesthepsychiatricunitwork? 91.4.2 AmIallowedaccesstoinformation

onmyfamilymemberorfriend’shealthcondition? 91.4.3 DoIhavetovisitmyfamilymember

orfriendeveryday? 101.4.4 WhatshouldIdoifmyfamilymember

orfriendwantstoleavethehospital? 101.4.5 DoIhavetoagreetoallmyfamilymember

orfriend’srequests? 11

InformationandsupportGUIDEII

1.4.6 MayIbringmyfamilymemberorfriendhisorherpersonaleffects? 11

1.4.7 ShouldItalktomyfamilymemberorfriendabouthisorherhealthproblem? 11

1.4.8 WhoshouldItalktoifIamdissatisfiedwiththecareorservicesprovided? 11

1.4.9 WhatcanIdowhenmyfamilymemberorfriendisreleasedfromhospital? 12

2. CONFIDENTIALITYANDPROFESSIONALPRIVILEGE 13

2.1 Confidentiality 13

2.2 Professionalprivilege 14

2.3 Exceptions 14

2.4 Thedifferencebetweenconfidentialandgeneralinformation 15

2.5 Winningconditions 15

3. PRACTICALADVICE 19

3.1 Provideeffectivehelp 193.1.1 Takecareofyourself 193.1.2 Stayinformed 203.1.3 Defineyourrole 203.1.4 Believeinyourfamilymember

orfriendandhisorherrecovery 203.1.5 Setasidetimeforyourself 203.1.6 Don’tblameyourselforfeelguilty 213.1.7 Don’tremainisolated 213.1.8 Don’tbeashamed 213.1.9 Don’tgiveuphope 21

III

3.2 Preventingrelapses 223.2.1 Positiveandnegativefactors

thatcanhaveanimpactontherecoveryprocess 223.2.2 Anticipatingacrisis 22

3.3 Dealingwiththreateningbehaviour 233.3.1 Reactingtoaggressivebehaviour 233.3.2 Dealingwithsuicidalthoughts 24

3.4 Copingwiththesymptomsofmentalhealthproblems 24

3.4.1 Hallucinationsanddelusions 243.4.2 Depressionandsocialwithdrawal 253.4.3 Disorganization 253.4.4 Breakdownincommunication 263.4.5 Stressandlossofcontrol 26

CONCLUSION 27

APPENDIX1 Listofmemberandnon-member

associationsoftheFédération des familles et amis de la personne atteinte de maladie mentale 29

APPENDIX2 Usefullinksandwebsitesforadditionalinformation 39

APPENDIX3Listofacronyms 43

BIBLIOGRAPHY 45

NOTES 47

1

PREAMBLE

In2009,afterconductingasurveytodeterminethelevelofsatis-faction of family members and friends with the services theyreceived,theInstitutuniversitaireensantémentaledeQuébecset up a working group whose mandate was to write a guideaddressingtheneedsandconcernsofthosehelpingintherecoveryofindividualswithmentalhealthproblems.

ThecommitteewascomposedofrepresentativesoftheInstitut,theCentrehospitalieraffiliéuniversitairedeQuébec (CHA),LaBoussole, Cercle polaire, and family members and friends1 ofindividualswithmentalhealthproblems.However,theworkinggroup’smandatequicklyexpandedfollowingtherequestoftheministèredelaSantéetdesServicessociaux(MSSS)tomakethetoolavailablethroughoutQuébecgiventheprovince-widelackofinformationandsupport.

To fulfill this expanded mandate, the committee added otherpartners, including the Fédération des familles et amis de lapersonne atteinte de maladie mentale (FFAPAMM) and theCentrehospitalieruniversitairedeQuébec(CHUQ).

The InformationandSupportGuide for familiesand friendsofindividuals with mental health problems is the product of twoyearsofhardworkandexceptionalcollaborationbyvariousinsti-tutionsinthenetwork.Theirworkmadeitpossibletocreateaguidetobetterpreparefamiliesandfriendsof individualswithmentalhealthproblemsandtoensurethatcommunicationflowsmore smoothly between them, the individual with a mentalhealthproblem,themedicalteam,andotherkeyplayersintherecoveryprocess.

1. Thismight include the father,mother,brother,sister,spouse,son,daughter,friend,oranyotherpersonwithaspecialinterestintheindividualwithamentalhealthproblem.

Preamble

2 InformationandsupportGUIDE

Intendedmainlyforfamiliesandfriendsofindividualswithmentalhealthproblems,thisguidecanalsobeusedasareferenceandsourceofinspirationbyhealthandsocialservicesnetworkworkerswhowishtocontinuouslyimprovetheirknowledgeandskills.

Theguideisdividedintothreesections.Thefirstprovidesinfor-mationontheorganizationofmentalhealthcareandservicesinQuébec,thesecondprovidesabriefoverviewoftheconceptsofconfidentialityandprofessionalprivilege,andthethirdprovidespractice advice on how to better help individuals with mentalhealthproblems.

The appendices include a list of community resources familiesandfriendsofindividualswithmentalhealthproblemscanturntoforhelpaswellasalistofusefullinksandwebsitesthatprovideadditionalinformation.

WetrustthatthisInformationandSupportGuideforfamiliesandfriendsofindividualswithmentalhealthproblemswillencourageyou to seek help from recognized mental health associations.Theycanprovidecaregiverswithmuch-neededsupport.

3

BACKGROUNDMentalhealthproblemshaveaprofound impacton individualssufferingfromthemandontheirfamiliesandfriendsaswellasonhealthcarecosts. InQuébec,onepersoninsixsuffersfromsomeformofmentalhealthproblem3.

Historically,theseindividualshavereceivedmentalhealthcareandservicesinahospitalsetting.Inthe1990s,theQuébecgovernmenttransformedmentalhealthservicesbyshifting the focus fromahospital-centredapproachtoacommunity-basedapproach.

Thewidespreadclosingofbedsintendedforpsychiatricpatients,thedecreaseinlonghospitalstays,andtheshiftawayfrominstitutionalto community-based support services not only changed mentalhealthpractices,italsohadamajorimpactontherolesexpectedoffamiliesandfriendsofindividualswithmentalhealthproblems.

In2005,inits2005–2010MentalHealthActionPlan(Pland’actionensantémentale2005-2010–La forcedes liens (PASM)),MSSSreaffirmedtheimportanceofthefamilyasanessentialresourceforkeepingindividualswithmentalhealthproblemsinthecommunity.Thiscommitmentledtotheestablishmentofguidelinestoensurethatprofessionalsinthehealthandsocialservicesnetworkstakeintoconsiderationtheneedsoffamiliesandfriendsforinformation,support,andalternativelivingarrangementsincareforindividualswithmentalhealthproblems.

3. MINISTÈREDELASANTÉETDESSERVICESSOCIAUX.Pland’actionensantémentale2005-2010–Laforcedesliens,Québec,2005,p.8.

Background


Theresultsofthesurveyconductedin2009bytheInstitutuniver-sitaireensantémentaledeQuébecalsoclearlyshowedtheneedoffamiliesandfriendsformoreinformationonmentalhealthill-nesses,theconceptsofconfidentialityandprofessionalprivilege,thetypesofsupportavailabletothem,andthestrategiestheycanusetocopewiththenewrealityofafamilymemberorfriendwithamentalhealthproblem.

Accordingtoastudyconducted in2001 (Provencher,Perreault,St-Onge, and Vandal), 60% of caregivers are subject to threetimesmoreemotionaldistressthanthegeneralpopulation.Thisindicatedhowimportantitisforfamiliesandfriendstotakecareof themselves toavoidadownwardspiralofdistressand tobeabletocarryouttheirrolesascaregiversinaneffectivemanner.

Regardlessofthediagnosis,age,gender,socialclass,orplaceofresidence,mostcaregiverswhohelpafamilymemberorfriendontheir way to recovery face similar difficulties, including a poorunderstandingofhowtoaccessthementalhealthnetwork, thedifficultiestheywillfaceaccessingthementalcareandservices,oralackofcooperationfromtheindividualwiththementalhealthproblemorfromhealthandsocialservicesprofessionals.

Thefamiliesandfriendsofindividualswithmentalhealthproblemsarethefront-linecaregivers.Theymustthusreceiveallthesupporttheyneedtocarryoutthisimportantrole.

5Organizationofservices

1. ORGANIZATION OF SERVICES

1.1 Organization of mental health care and services in Québec

Afewdefinitionsaregivenbelowtohelpyouunderstandsomeofthetermscommonlyusedinthefieldofmentalhealthservicesandbytheinstitutionsthatprovidethem.

1.1.1 Primary care servicesPrimarycareservices,includingmentalhealthservices,areavailabletoeveryone.Theirpurposeistopromotehealth,preventdiseases,andprovidediagnostic,curative,andrehabilitationservicestoall.Theyareprovidedinthecommunity,i.e.,ascloseaspossibletousers.Thepeoplewhoprovidetheseserviceswillguideyouinthestepstotake.Primarycareisprovidedbyhealthandsocialservicescentres (CSSS), medical clinics, family medicine groups (FMG),certaincommunitygroups,privateconsultingofficesand, inthecaseofemergencies,hospitalemergencyrooms.

1.1.2 Secondary care servicesThesecompriseservicesthatunderpinprimarycare.Thepeoplewho receivecareandservicesat secondarycare locationsarenormally referred there by a primary care worker. Secondarycare relies on specialized expertise to treat people with moresevereproblemsthatcannotbetreatedinaprimarycaresetting.Secondarycareismainlyprovidedinhospitals.

1.1.3 Tertiary care servicesTertiarycareunderpinsprimaryandsecondarycareandprovidestreatment for people with more serious problems that requirespecializedservices.Tertiarymentalhealthcareservicesareonlyprovidedininstitutionsthatspecializeintheseservices.


1.2 CSSS (CLSC mission)

1.2.1 If your family member or friend has a family physicianIfyourfamilymemberorfriendwithamentalhealthproblemhasafamilyphysicianwhoagreestomanagehiscare,thephysiciancancountonthesupportofaCSSSmentalhealthteam.

1.2.2 If your family member or friend does not have a family physician

WhenyourfamilymemberorfriendgoestotheCSSS,hewillmeetwithaprofessionalwhowillperformanevaluationanddirecthimtotheresourcethatcanbestaddresshisneeds.Theprofessionalwilldeterminewhethertheindividualmustbereferredtoaprimarycarementalhealthteam.Thisteam,whichiscomposedofvariousprofessionals (psychologists, social workers, nurses, physicians,etc.), is the main “gateway” to the mental health network. Yourfamilymemberorfriendmaybetreatedbythisteamorreferredtosecondaryortertiarycareservices,dependingonhisneeds.

Youmaywellexperienceawaitingperiod.Inthemeantime,youcanfind out about the various services available to you. Please beawarethattheCSSSisnotrequiredtotakeoneachandeverycase.

1.2.3 In either situationAsacaregiver,youcanprovidetheCSSSworkerwithinformationonyourfamilymemberorfriendatanytime.Youcanalsoasktheworkerforgeneralinformationonthenextstepsandtheservicesavailableinyourcommunity.Youwillhavetospecifythatyouhaveaspecialinterestinyourfamilymemberorfriendandthatyouarehis caregiver. Professional privilege prevents the worker fromdivulging personal information about your family member orfriend.However,theworkercanprovideyouwithinformationofageneralnature,canlistentoyouifyouhaveinformationtoshare,and can give you the contact information of your local mentalhealthassociationdedicatedtofamiliesandfriends.


Itisimportantthatyoudiscussyourroleasacaregiverwithyourfamilymemberorfriend.Heshouldbeencouragedtoinvolveyouinhisorhertreatment,subjecttoprivacyconsiderations.

Verifywiththefamilymemberorfriendthetypeofinformationthathe or she feels the CSSS worker should disclose to you.Collaborationisanessentialingredientintherecoveryprocess.It is also important to determine the limits of the help that you are able to provide to your family member or friend.

1.3 Hospital emergency services“Emergency”describestheseservicesperfectly,i.e.,theurgencytoact.Whenthesituationhasgottenoutofcontrol,symptomsaretrulyserious,andyoucan’treacheithertheattendingphysicianorthecrisiscentreinyourarea,youcantakethefamilymemberorfriendwithamentalhealthproblemtothenearestemergencyroom.Inexceptionalcases,whenanindividualrefuseshelp,youcanaskforacourtorderorforapoliceofficertoaccompanyyoutothehospitalemergencyroom.

When youarriveat theemergency room, your familymemberorfriendwillbeseenbyanurse.Providethenursewithadescriptionoftheperson’sattitudesandbehaviour.Giventhesignsandsymptomsofmentalillness,askifyoucanbothwaitinaquietroom.

ThesecondstepistomeetwithanERphysician,whowill evaluate your family member or friend and who may also ask for a psychiatric assessment.Dependingontheresultsoftheevalua-tions,ifthereisadangertothepersonortoothers,hemaybekept under observation in preventive confinement. According totheActrespectingtheprotectionofpersonswhosementalstatepresentsadangertothemselvesortoothers,ifapersondoesnotpresentadangertohimselforherselfortoothers,thephysicianmustreleasethepersonifheorshewantstoleavethehospital.


Ifapsychiatricassessmentisrequired,youcanasktobepresent.Yourrequestmaybeaccepted ifyour familymemberor friendconsentstoitandifthesituationpermits.However,ifherefuses,youcanstillaskforgeneralinformationonwhatthenextstepswillbe.Insuchcases,weencourageyoutoaskforhelpfromasocialworkeratthehospital,whowillthenguideyouthroughthetreatmentsteps.Alsorememberthatyoucanbroachtheissueofconsentwithyourfamilymemberorfriendatanytime.

Attheendoftheconsultation,yourfamilymemberorfriendmaybehospitalized, released,or referred toanotherhospital.Feelfreetoaskthephysicianforthereasonsforhisorherdecision.

If your family member or friend returns home, you can stillrequestinformationonthemosthelpfulattitudestoadoptandonwaystopreventrelapses.Reachoutforhelpwithyourproblem.Askforthelistofavailablecommunityresourcesthatcanprovidesupportandhelpyoucope.(seeAppendix1)

Ifyourequirehelpandsupport,don’tbeafraidtocontactthementalhealthassociationdedicatedtofamiliesandfriendsinyourarea.

Whileemergencyservicesvaryfromhospitaltohospital,youcanasktomeetwithasocialworker.Heorsheisnormallyavailableatcertainhoursandcanprovidegeneralinformationonmentalhealthproblems,offersupport,andreferyoutotheappropriateresources.Ifyouhavequestionsofamedicalnature,youcanasktomeetwiththeattendingphysicianoranurse.Askaboutthetypesofemergencyservicesprovidedandthevisitinghours.


1.4 When a family member or friend is hospitalizedWhenthementalhealthofyourfamilymemberorfriendrequireshospitalization,a fewquestionswill likelyspring tomind.Don’thesitatetoaskthem.Theanswersyoureceivewillhelpyoufulfillyourroleasacaregiver.Theywillalsoreassureyouandwillcreateatrustingrelationshipwiththemedicalteamtreatingyourfamilymember or friend. Answers to the questions most frequentlyaskedbycaregiversaregivenbelowasaguide.

1.4.1 How does the psychiatric unit work?Wesuggestthatyouwritedownthenamesofthestaffcaringforyour family member or friend, i.e., the patient case manager(generallyanurse),theunitchief,thepsychiatrist,andthesocialworkerassignedtotheunit.Theycanprovideyouwithgeneralinformationonhowtheunitworks.Documentationisalsoavailable,andinformationmeetingsareoccasionallyarrangedforfamilies.Feelfreetoaskaboutthesemeetings.

Giventheworkloadandavailabilityofthestaff,werecommendthat you designate one person to act on behalf of your familymemberor friend.Thiswillmake iteasier togiveandreceiveinformation and will be greatly appreciated by the healthcareproviders. Stay in regular contact with the providers and givethemallinformationyoudeemrelevant.

Follow-upmeetingsmaybeorganizedforpatients.Ifthepatientagrees,close familymembersand friendsmaybe invited.Askwhetheryouwouldbeabletoattendthesemeetings.

1.4.2 Am I allowed access to information on my family member or friend’s condition?

If your family member or friend (the patient) consents to yourreceiving information on her health, hospital staff will provideyouwithconfidential information(diagnosis,treatment,etc.). Ifthepatientrefuses,youwillonlyreceiveinformationofageneralnature(howtheunitworksandavailableresources).


1.4.3 Do I have to visit my family member or friend every day?Everycaseisunique.Whenyourfamilymemberorfriendishos-pitalized,askthepatientcasemanagerforadviceonhowtoactduring meetings/visits. It is important to collaborate with themedicalteamandtorespectyourlimitsandthoseofthepatient.

Duringthefirstfewvisits,youmayfeelupset–thesamegoesforyourfamilymemberorfriend.If you feel too uncomfortable, give yourself time and spread out your visits.Yourfamilymemberorfriendmayalsorefusetoseeyouforvariousreasons.Thiscansometimesbedifficulttoaccept. Ifthishappens,resourcesareavailabletoprovidesupport.

1.4.4 What should I do if my family member or friend wants to leave the hospital?

The first contact with a psychiatric environment is generally ashockbecauseotherpatientsmayappearworseoff thanyourfamilymemberorfriend.

Duringthehospitalization,youmayhavetodealwithyourfamilymemberorfriend’sinsistencethatshegohome.Youmayalsohavetodealwithyourownurgetogetheroutofthehospitalasquicklyaspossible.

Be vigilant and patientbecause,despitealltheuncomfortableemotionsyoufeel,thehospitalcanbearefugeatatimewhenyourlifeandthatofyourfamilymemberorfriendisoverwhelmedwithanguish.

Hospitalizationisonestep.Youhavetoacceptthefactthattheobservationperiodandthestartofthetreatmentwilltaketime.

Hospitalization isoftenadifficultstep,butyouhavetokeep inmind that thehospital isoneof theplaceswherea treatmentplantohelpyourfamilymemberorfriendcanbedeveloped.


Duringvisitswithyourfamilymemberorfriend,beunderstanding,but remain firm and convinced of the need for hospitalization.Avoid futileargument,butmakesuresheunderstands thatyouaretheretohelp.Emphasizethehopethatshewillfindabetterbalance.Spaceoutyourvisitsifyoufindthepressureistoogreat.

1.4.5 Do I have to agree to all my family member or friend’s requests?

No.Useyour judgment. Ifyoudoturndownarequest,explainwhyyoudidso.

1.4.6 May I bring my family member or friend his or her personal effects?

Unlessotherwisespecified,youmay.Ifyouhaveadoubt,askastaff member. They may ask to see things you bring. Suchrequests are made simply to ensure the safety of your familymemberorfriend,otherpatients,andstaff.

1.4.7 Should I talk to my family member or friend about his or her health problem?

Caregiversoftenwonderwhethertheyshouldmeetthisissueheadonoravoidit.Italldependsonhowyouandyourfamilymemberorfriendfeel.Youshouldbefrankatalltimeswhilerespectingeachother’s limits. You can raise this issue with the patient’s casemanager,whowillhelpyoudeterminetheappropriateapproach.

1.4.8 Who should I talk to if I am dissatisfied with the care or services provided?

Youshouldfirsttalkwiththemedicalteam,especiallythenurse.If theanswerstoyourquestionsortheproposedsolutionsareunsatisfactory, you can consult the unit chief. If you are stilldissatisfied, youcanfileacomplaintwith the localcomplaintsandservicequalitycommissioner.Thestaffintheunitwillgiveyouthecommissioner’scontactinformation.


Ifyouwouldliketoknowhowcomplaintsaredealtwith,youcancontactthementalhealthassociationdedicatedtofamiliesandfriends in your area or consult the Practical Guide to MentalHealth Rights – Answers to questions by family and friends ofindividualswithmentalhealthproblems,whichyoucandownloadfromtheMSSSwebsite:www.msss.gouv.qc.ca.

1.4.9 What can I do when my family member or friend is released from hospital?

Youcanrequestameetingwiththepatientcasemanagertofindoutmoreaboutthereleaseconditionsandyourcaregivingrole.Withtheconsentofyourfamilymemberorfriend,askthemedicalteamaboutfollow-upsteps,thenamesandtelephonenumbersof people to contact, wait times for appointments, the list ofmedications,thecontactinformationofthedrugstore,andalistofcommunityorganizationsyoucancontactifneeded.Also,askwhere to go if your family member or friend’s mental healthdeteriorates.

13Confidentialityandprofessionalprivilege

2. CONFIDENTIALITY AND PROFESSIONAL PRIVILEGE

Confidentialityandprofessionalprivilegeareconceptsyoumayhavequestionsabout.Theycanevenleadtofrictionbetweenyouandyourfamilymemberorfriend,orwithmembersofthemedicalteam.Thesetwoconcepts,whileimportantanddefinedbylegis-lation,canbeseenasamajorbarrierbythefamilyandfriendsofapatient.Youmayfinditdifficulttounderstandoreveninadmis-siblethatyoucan’thaveaccesstocertaininformationregardingyour family member or friend during his hospitalization, eventhough you are the closest caregiver. The legal underpinningsandpracticalapplicationof theconceptsof confidentialityandprofessionalprivilegeareoutlinedbelow.

2.1 ConfidentialityTheCivilCodeofQuébecisthebasisofcommonlawandservesasthefoundationforQuébeclegislation.Theprincipleofconfi-dentialityisbasedoneveryperson’srighttotherespectoftheirdignityandtheirprivate lifeassetout inSection3of theCivilCode.Thismeansthataccesstoinformationdeemedconfidentialislimitedtothosepeopleexpresslyauthorizedtoaccessit.

Unlessauthorizedbyyourfamilymemberorfriend,legislationstipulatesthatnoemployeeorprofessionalworkingorpracti-cinginahealthandsocialservicesinstitutionoracommunityorganizationcangiveyouconfidentialinformationonyourfamilymember or friend. This principle applies to all information,whetherwritten,verbal,orinamedicalfile.


2.2 Professional privilegeInadditiontotheobligationofallworkersinthehealthandsocialservicesnetworkandcommunityorganizations to respectconfi-dential information, all members of a professional order havethe obligation to respect professional privilege. This means thattheycannotdisclosepersonal informationtoyouconcerningthepersonyouarecaringfor(diagnosis,resultsofanalyses,treatments,evaluations,etc.).

Wewouldliketodrawyourattentiontothefactthatyoucangiveinformationonyourfamilymemberorfriendtoahealthprofessionalatanytime.Youcanalsoaskthatthisinformationnotbedisclosedtoyourfamilymemberorfriend.However,youhavetorememberthatthehealthprofessionalmustmaintainhisorhertherapeuticrelationshipwithyourfamilymemberorfriend.Thismeansthatthereisnoabsoluteguaranteethattheinformationwillneverreachyourfamilymemberorfriend.Thehealthprofessionalwillbeguidedbythebestinterestsofyourfamilymemberorfriend.

2.3 ExceptionsTherearetwo situationswhenanemployeeorhealthprofessionalcanbreak theruleofconfidentialityorberelievedofhisorherobligationtorespectprofessionalprivilege:

1.When your family member or friend authorizes him or her to give you the information(verbalorwrittenauthorization).

2.Exceptions,suchas:• Topreventanactofviolence;• Whenapersonisconfinedinaninstitution(informationcon-

cerningtheconfinement,endofconfinement,andtreatmentplanprovidedtothelegalrepresentativeoftheconfinedperson);


• Whenapersonoffullageisincapableofgivingconsenttocare(subjecttolegalsteps);

• Whenthesafetyordevelopmentofa-minoriscompromised.

2.4 The difference between confidential and general information

Itispossible,unlessyourfamilymemberorfriendauthorizesit,thatyouwillnotreceiveanyconfidentialinformationatallonyourfamilymemberorfriend,i.e.,anyinformationspecificallyrelatedtohismedicalfile,includingobservationnotesandfollow-upcareoutsidethehospital,ortotheobjectivesandstepsrelatedtohisfollow-upcareinthecommunity.

However,healthprofessionalsstillhavetherighttogiveyougeneralinformationonmentalhealthproblemsandonservicesprovidedbythehospitalandbycommunityorganizations.

Theyalsohavetherighttoofferyoupracticaladviceonhowtodealwiththesymptomsanddifficultbehaviourofyourfamilymemberorfriend.Feelfreetoaskthemanyquestionsyoumayhave.

2.5 Winning conditionsFocusonthewinningconditionsneededtopromotearelationshipoftrustbetweenyou,yourfamilymemberorfriend,andthehealthprofessionalsassignedtohiscare.Withtheconsentofyourfamilymember or friend, you can get actively involved as a caregiver,whilerespectingthedirectivesofthehealthprofessionals.


Keepinginmindtheapplicationoftheprinciplesofconfidentialityandprofessionalprivilege,herearesome winning conditions you can focus on to facilitate your participation:

• When circumstances permit, talk openly with your familymemberorfriendaboutthepossibilityofgettinginvolvedinhisfollow-upcare.

• Ifheagrees,askhimorhertonotifythemedicalteam,sothattheteammemberscandivulgeconfidentialinformationonhiscare(diagnosis,medications,etc.).

• Reassureyourfamilymemberorfriendaboutyourdegreeofinvolvementbytellinghimthatyoudon’thavetoknowevery-thingaboutthefollow-upcare,justthemaininformationthatwillhelpyoutounderstandhisproblemand,assuch,providethemostappropriatesupportduringthevariousstepsofhisrecovery.

• Your familymemberor friendmaynotbecooperativeandmayrefuseyouroffertohelpforvariousreasons.Ifthishap-pens,youcancallonthepatientcasemanagerforhelp.Itissometimeseasierforastrangertoexplaintheimportanceofyourinvolvement.

• Mention to the health professionals that you understandthe concepts of confidentiality and professional privilegeand that,assuch,youunderstand that there isa limit towhat they can tell you. Remember that they can’t breaktheirprofessionaloath.

• Makethetaskofcollectinginformationeasierbycollaboratingwiththehealthprofessionalsandgivingthemverbalorwritteninformation on the behaviour and attitudes of your familymemberorfriend.Determinethebesttimetodothisbasedontheirindividualschedules.


• Voiceyourconcernsandworriesaboutyourroleasacaregiver.• Determine whether the health professionals have specific

expectationsofyou,andtellthemhowmuchsupportyoucanprovide to your family member or friend (accommodations,day-to-dayinvolvement,financialsupport,etc.).

Trytoremaincalmandpositiveatalltimes.Evenifyourfamilymemberorfrienddoesnotatfirstconsenttohealthprofessionalsdisclosingpersonalinformationtoyou,hemaychangehismindlaterduringthetreatmentprocess.Youwillhavetorespectthepaceofthecollaborativeprocess.

Inshort,healthprofessionalshavetorespecttheirobligationsregardingconfidentialityandprofessionalprivilege.However,rememberthatyouhavetherighttoprovidethemwithanyinforma-tionthatcanhelpintherecoveryoftheindividualyouarecaringfor.

Torecap,youwillhaveto:• Askforthecollaborationofyourfamilymemberorfriendand

themedicalteam.• Respect the principles of confidentiality and professional

privilege.• Getactivelyinvolvedinsharinginformationaboutyourfamily

memberorfriend.• Defineyourlimitsasacaregiver.• Bepatientandrespectthepaceofyourfamilymemberor

friend.

19Practicaladvice

3. PRACTICAL ADVICECaringforafamilymemberorfriendwithamentalhealthprob-lemisnoteasy.Itrequiresasteeplearningcurveandavarietyofstrategies for adapting. For most people, the world of mentaldisordersisveryforeign,andwhenafamilymemberorfriendisdiagnosed with a mental health problem they often react withdisbelief,worry,andanguish.

Forthisreason,asafamilymemberorfriendofanindividualwithamentalhealthproblem,youwillhaveaccesstobasicsupportandinformation tohelpyoudealwithcertainsituations. It isnormalandnaturaltowanttodoeverythingyoucantohelpyourfamilymemberorfriendbecauseyoulovethatperson.Thisdesireisevenstrongerwhenyouseetheirdistress.But,yourhelpandsupportcannot, on its own, solve the problem. Your family member or friend requires, first and foremost, professional care.

You may disagree, but remember that your family member orfriendisresponsibleforhisorherownlifeandchoices.

3.1 Provide effective help

3.1.1 Take care of yourselfItiscommonforcaregiverstoburnout.That’swhytheyneedtocareforthemselves–it’seasyforthemtoforgettheirownneeds!Learn to recognize signs of stress and fatigue and to set your own limits.Itisdifficulttohelpsomeonewhenyouareexhausted.Maintainahealthylifestyle(rest,dailyactivities,etc.).Thepersonyouarecaringforalsoneedstofindabalancedlifestyle.Bytakingcareofyourself,youareencouragingthatpersontodothesame.


3.1.2 Stay informedLearn to make the distinction between the signs of a difficult day and symptoms of the mental health problem.Havingbeenthroughanumberofpainfulepisodes,youmaybecometoovigilant.Knowing the symptoms, causes, and treatments of the illnesscan help you recognize the difference. Encourage your familymemberorfriendtocontinuetheprescribedtreatment.However,ifthepersonwantstostopthetreament,suggestthatshefirstdiscuss the decision with her family physician, psychiatrist, orpharmacist.

3.1.3 Define your roleYou are not the physician, social worker, or nurse of your family member or friend.Yourfamilymemberorfriendmaybereceivinghelpfromanumberofprofessionalsinthehealthandsocial services or community services network. It is essential that you keep to your role as a caregiver.Seekhelpforyourselftofindouthowtodevelop“caregiving”attitudessothatyoucan,inturn,helpyourfamilymemberorfriend.

3.1.4 Believe in your family member or friend and her recoveryThepersonyouarecaringforisendowedwithherownintelligenceandpersonality,andcandothingsatherownpace,basedonhervaluesandpriorities.It’simportanttomakethedistinctionbetweentheperson’spaceandprioritiesandyourown.

Don’t act in her stead. The illness and relapses are out of yourcontrol.Youhavenopoweroverthechoicesandbehaviourofyourfamilymemberorfriend.However,youdohavepoweroveryourown.

3.1.5 Set aside time for yourselfContinue your normal activities and set aside some time to care for yourself.Dividehouseholdchoresamongotherfamilymembers.Doanactivityyoulikeandthatmakesyoufeelgood.Enjoylife!

21Practicaladvice

3.1.6 Don’t blame yourself or feel guiltyBe realistic about your expectations to avoid disappointment.Despitethetimeandenergyyoudevotetothecareofyourfamilymemberor friend,youshouldn’t feelguiltyabout theperson’schoices,theircondition,ortheevolutionoftheirillness.Youarenotresponsibleforwhatishappeningtothatperson.

3.1.7 Don’t remain isolatedSeek out help andanunderstandingear.Confide inpeopleyoucantrust.Tellthemwhatyouaregoingthroughandremember,other members of your family are also affected. If you feel theneed, contactamentalhealthassociationdedicated to familiesandfriendsforsupportandinformation.

3.1.8 Don’t feel ashamedDon’t feel ashamed to say that a family member or friend has a mental health problem.Thisisthefirststepinthebattleagainstprejudice.KeepinmindthatoneinsixQuebecerssuffersfromoneformoranotherofmentalillness.4

3.1.9 Don’t give up hopeHopewillberekindledwhenyourealizethatyour role is to care foryourfamilymemberorfriendalongtheroadtorecoveryandnot to heal her or act in her stead. A combination of patience,respectforyourselfandothers,helpfromothers,andaffection,willallowyoutoteamupwithyourfamilymemberorfriendandtraveltheroadtorecoverytogether.

4. MINISTÈREDELASANTÉETDESSERVICESSOCIAUX.Pland’actionensantémentale2005-2010–Laforcedesliens,Québec,2005,p.8.


3.2 Preventing relapsesArelapseispossibleatanytimeduringtherecoveryprocess.Arelapseisdefinedasthereappearanceortheworseningofsymp-tomsofanillnessthatseemedtobegettingbetter.

3.2.1 Positive and negative factors that can have an impact on the recovery process

Thepersonyouarecaringformayhavesomedegreeofcontroloverrelapses, provided she understands the illness and prescribedtreatments.Otherfactorsmayplayapositiveroleinmaintainingherwell-beingsuchasdeterminingsourcesofstressandcontrollingthemandadoptingahealthylifestyle(meals,sleep,activities,etc.).However,arelapseisalwayspossibledespitepreventivemeasures.

Certainfactorscancauseadeteriorationinthementalhealthofyourfamilymemberorfriendsuchasnottakingmedicationasprescribed,highstresslevels,andconsumingalcoholordrugs.Thesesubstancescanalsointeractwithcertainmedicationstodecreaseorincreasethedesiredeffects.

3.2.2 Anticipating a crisisItcanbereassuringtohaveaplanforreactingtoacrisis.Chooseatimewhenyourfamilymemberorfriendisdoingwellorbetterandagreetogetheronwaystopreventthedeteriorationofhermental health (contact her family physician, bring forward theappointment with the professional managing her out-patientcare,etc.).

Together, choose the person who will accompany your familymemberorfriendtothehospital.Ideally,thiswouldbesomeoneindailycontactwithherandwhocandescribethechangesleadinguptoacrisis.

23Practicaladvice

If,despiteallthesepreventivemeasures,yourfamilymemberorfriendisnolongercapableofmakingtreatmentdecisions,youwillhavetoinformherofthestepsthatmaybetakentoensureher safety in the event she presents a danger to herself or toothers.Youcancontactamemberornon-memberassociationofFFAPAMMforadviceonthelegalmeasuresgoverningsuchasituation.Keeptheemergencytelephonenumbersandcontactinformationoftheorganizationsthatcanhelpyoucloseathand(seeAppendix1).

3.3 Dealing with threatening behaviour

3.3.1 Reacting to aggressive behaviourAggressivity is an emotion that may arise when someone isdissatisfedwiththeresponsetotheirphysical,psychological,orsocialneeds.Thepersonisfrustratedbecausesheexperiencesfeelingsofdisempowerment,despair,andevenfailure.Thepersonthenseekstoalleviatethesufferingthroughaggressiveandhostilebehaviour.

Whensomeonedisplayssuchbehaviour,itisimportanttorespecttheperson’spersonalspace.Keepacertaindistancesothatthepersondoesn’tfeelinvaded.Ifthepersonbecomesaggressive,trytalkingtoherusingacalmvoice,withoutbeingjudgmental.Assessthenatureandintensityoftheperson’semotions–fearandanger, for example. Let the person know that you won’t tolerateviolenceorunacceptablebehaviour.

Pull back if you feel uncomfortable or in danger. Considerseekinghelp.Inthesecases,itmaybeappropriatetocontactthepolice.


3.3.2 Dealing with suicidal thoughtsPsychologicalsufferingcanbecomesointensethatapersonmaysee suicide as the only solution to her problem. You have tounderstandthatthepersondoesnotwanttodie,onlytoputanendtothesuffering.Whenthebehaviourandwordsofyourfamilymember or friend point to suicidal thoughts, you have to talkopenlyaboutittogether,sharingyourfearsandobservations.Askyour family member or friend if she has thought of commitingsuicide(how,where,when).Talkingaboutsuicidewithsomeonewillnotincitethemtocommitsuicide.Onthecontrary,itshowsthepersonthatyouareconcerned.However, all talk of suicide should be taken seriously. You can call the suicide preventioncentreinyourarea,whichalsoprovideshelpforthefamilyandfriendsofsuicidalpeople.

3.4 Coping with the symptoms of mental health problems

3.4.1 Hallucinations and delusionsHallucinationsareadistortionofaperson’sperceptionofreality.Apersonmayseethingsthatdon’texist,heartormentingvoices,havethe feelingofbeingtouched,orsmellanodourthat isn’tthere. Hallucinations can make the person feel threatened orpersecuted. Delusions, on the other hand, impair a person’sabilitytoreasonandcanleadtofalsebeliefs.Forexample,delu-sional people may be convinced that they are the target of amurdererorthattheyareresponsibleforallthetroublesintheworld.Hallucinationsanddelusionscandrawthepersonintoaworldofanxiety.You have to remember that what your family member or friend is experiencing is real to him because it is a symptom of his illness.

Ifyourfamilymemberorfriendasksyouforadvice,behonestandsimplyanswerthatyoudon’tperceivethingsthesameway.

25Practicaladvice

3.4.2 Depression and social withdrawalNegative thoughts are painful. Depressed people often feelawkward,inadequate,andworthless.Theymayhavetheimpres-sion that no one loves them. They have no energy or interestinsocialinteractionsandbecomemoreandmorewithdrawn.Ifthishappens,try to maintain contact with your family member or friend, while accepting your own limits. Try directing yourfamily member or friend to other caregiving resources. Stayupbeat. Be positive. Be understanding, loyal, encouraging, andnurturing.Instillself-worthandhopeinyourfamilymemberorfriend.Yourattitudecanhelphimbuildhealthyself-esteem.Hemayneedtotakemedicationsuchasananti-depressant.Thesedrugsusuallyyieldgoodresultsaftertwotosixweeks.

3.4.3 DisorganizationCertain illnessescause temporarycognitive impairmentssuchas memory impairment, trouble concentrating, disorientation(nolongerknowingwhereoneisorwhatdayitis),anddisorgan-ization(doingthingsinadisorderlyway).Thiscancauseanxietyandcommunicationproblems.

If your familymemberor friendshowssignsof confusionandworry,approachhimslowly,establishinggoodeyecontact.Talkslowly.Ifotherpeoplearepresent,itisbestthatonlyonepersontalktohim.Useshort,simplesentences,andgivehimtimetoanswer.Don’taskhimtoconcentratemore.Deliver one message at a time, and repeat the information, without criticizing. Ifwarranted,situatethepersonintimeandinhisenvironment.Youcanusefamiliarobjectstohelpyoudothisandtostimulatetheperson’smemory.Avoidsayingthingslike“Youshouldn’tdothis.Don’tdothat.”Don’tdrawattentiontomistakes.


3.4.4 Breakdown in communicationThelanguageofpeoplewithmentalhealthproblemsmaybecomeincomprehensible,eitherbecausetheirsentencesarenotlogicalorareincoherent,orbecausetheyjumprapidlyfromonetopictoanother.Generallyspeaking,thishappensintheacutephaseofthe illness, although communication may be difficult at othertimesinthecourseofthetreatment.Listen attentively without attempting to make sense of something that is not logical to you.Rather,focusontheemotionsbeingfeltbyyourfamilymemberorfriend.Bepatient.Thistypeofsymptomgenerallyrespondswelltodecreasesinstressandadjustmentsindrugdosages.

3.4.5 Stress and loss of controlPeoplesufferingfromanxietydisordersaresubjecttoanintense,recurring,andprolongedsenseoffear,butareoftenunawareofthecause.

Ifyourfamilymemberorfriendisinthistypeofsituation,talktohimslowlyandcalmly.Takethepersontoarelaxingplace,andreassurethepersonabouthisabilitytoregaincontrolandfindsolutions. Just being there will allow the person to talk aboutwhat isworryinghim.Encouragethepersontousewaysheisfamiliarwithtopreventormanagethestress.

Incaseswherethesymptomsaresoseverethatthepersonmaybeadangertohimself,toyou,ortoothers,seekhelporcall911.

27Conclusion

CONCLUSIONCaringforafamilymemberorfriendwithamentalhealthproblemisadifficultexperience.Itrequiresyoutosurpassyourselfandlearnnew things.Thereareanumberofways toadapt to thementalillnessofafamilymemberorfriend.Thechoicesareasvariedasthepeopledealingwiththisreality.Thereare,ofcourse,essentialelementscommontoall, likethosedescribed in thisguide.Weencourageyoutocontinueyourresearch.Byreadingthisguideyouhavelikelylearnedsomebasicsoftheorganizationofmentalhealthcareandservicesandofmentalhealthproblems.However,byseekinghelpfromthoseexperiencedincaringforindividualswithmentalhealthproblemsthatyouwillbeabletograduallydiscoveranddevelopyourfullpotentalasacaregiver.Dealing with mental illness is difficult, but it is also enrichinginsofar as it helps you to develop personal strengths that youperhapsdidn’tknowyouhad.

Wewishyougoodluckinyourlifejourney.Don’tbeafraid—youwillfindthebalanceyouneedtoattainthefeelingofwell-beingyoulongfor.Andremember,aboveallelse,alwaysseekouthelpwhenyoufeeltheneed!

List of member and non-member associations of the Fédération des familles et amis de la personne atteinte de maladie mentale

Appendix 1


FFAPAMM1-855-272-7837 www.avantdecraquer.com

Bas-Saint-LaurentLalueurdel’espoirduBas-Saint-LaurentRimouski418-725-25441-877-725-2544www.lueurespoirbsl.org

Saguenay–Lac-Saint-JeanCentreNelliganRoberval418-275-0033www.centrenelligan.com

Capitale-NationaleLaBoussoleQuébecCity418-523-1502www.laboussole.ca

LaMaréeLaMalbaie418-665-00501-877-523-2881www.lamaree.ca

CerclePolaireQuébecCity418-623-4636www.cerclepolaire.com

31Appendix1

L’Arc-en-CielDonnacona418-285-3847

Mauricie–Centre-du-QuébecAPAMECentre-du-QuébecDrummondville819-478-1216www.apamedrummondville.org

LePériscopeGrand-Mère819-729-1434www.leperiscope.org

LaLanterneTrois-Rivières819-693-2841www.lalanterne.org

AssociationLePASVictoriaville819-751-2842www.lepas.ca

LeGyroscopeLouiseville819-228-2858www.legyroscope.org

LaPasserelleBécancour819-233-9143


EstrieAPPAMMdel’EstrieSherbrooke819-563-1363www.appamme.org

MontréalAssociationdesparentsetamisdubien-êtrementalduSud-OuestdeMontréalVerdun514-368-4824www.apabemso.org

LaParentrieMontréal514-385-6786www.laparentrie.org

AMI-QuébecMontréal514-486-14481-877-303-0264www.amiquebec.org

LesAmisdelasantémentaleFriendsformentalhealthDorval514-636-6885www.asmfmh.org

33Appendix1

OutaouaisL’ApogéeGatineau819-771-64881-866-358-6488www.lapogee.ca

Abitibi-TémiscamingueVALPABEMVald’Or819-874-02571-877-874-9399

LaRescousseAmos819-727-4567

LePortailRouyn-Noranda819-764-4445

LaBouéed’espoirLaSarre819-333-1184www.labouee.osblquebec.org

Côte-NordAPAMEdel’estdelaCôte-NordSept-Îles418-968-04481-888-718-2726www.apame.net


APAMEBaie-ComeauBaie-Comeau418-295-2090

Gaspésie–Îles-de-la-MadeleineCentrecommunautairel’ÉclaircieÎles-de-la-Madeleine418-986-6456www.eclaircie.ca

Chaudière-Appalaches/BellechasseLeContreventLévis418-835-19671-888-835-1967www.contrevent.org

L’AncreMontmagny418-248-0068

LeSillonSaint-Georges418-227-6464www.lesillon.com

LaCroiséeThetfordMines418-335-1184

35Appendix1

LavalALPABEMLaval450-688-05411-888-688-0541www.alpabem.qc.ca

LanaudièreLalueurdupharedeLanaudièreJoliette450-752-45441-800-465-4544www.lueurduphare.org

MontérégieAPAMMRive-SudGreenfieldParkLongueuil450-677-5697www.apammrs.org

LeVaisseaud’OrSorel-Tracy450-743-2300web.me.com/noursqc/vaisseau/Bienvenue.html

OasissantémentaleGranbyandareaGranby450-777-71311-877-777-7157www.oasissantementale.org


ÉclusierduHaut-RichelieuSaint-Jean-sur-Richelieu450-346-5252www.eclusierhr.ca

L’AccoladeSantémentaleChâteauguay450-699-70591-866-699-7059www.accoladesantementale.org

LePhare,Saint-HyacintheandareaSaint-Hyacinthe450-773-72021-877-773-7202www.lephare-apamm.ca

LePontduSuroîtSalaberry-de-Valleyfield450-377-31261-888-377-4571www.lepont.com

Other resources and non-member associations of FFAPAMM

MontréalSociétéquébécoisedelaschizophrénieMontréal514-251-41251-866-888-2323www.schizophrenie.qc.ca

37Appendix1

AQPAMMMontréal514-524-7131www.aqpamm.ca

APSMdeSaint-Laurent-Bordeaux-CartiervilleMontréal514-744-5218pages.videotron.com/apsm

Gaspésie–Îles-de-la-MadeleineNouveauregardNewRichmond418-392-64141-888-503-6414www.nouveauregard.qc.ca

LaurentidesALPPAMMSaint-Jérôme450-438-42911-800-663-0659www.alppamm.org

MaisonClothildeMont-Laurier819-623-3843www.maisonclothilde.org

Saguenay-Lac-St-JeanLeMaillonChicoutimi418-543-34631-877-900-3463www.lemaillon.com

Useful links and websites for additional information

Appendix 2


Listofthe95healthandsocialservicescentres(CSSS)inQuébecwww.msss.gouv.qc.ca/repertoires/csss

CanadianMentalHealthAssociationwww.acsm.ca

Association des groupes d’intervention en défense des droits en santé mentale du Québecwww.agidd.org

Association québécoise de prévention du suicidewww.aqps.info

Association québécoise pour la réadaptation psychosocialeaqrp-sm.org/index.html

Association / Troubles anxieux du Québec (ATAQ)www.ataq.org

MentalIllnessFoundationwww.fondationdesmaladiesmentales.org/en

Hôpital Louis-H. Lafontainewww.hlhl.qc.ca

Institut Philippe-Pinelwww.pinel.qc.ca

Institut universitaire en santé mentale de Québecwww.institutsmq.qc.ca

DouglasMentalHealthUniversityInstitutewww.douglas.qc.ca

41Appendix2

ActrespectingtheProtectionofpersonswhosementalstatepresentsadangertothemselvesortootherswww2.publicationsduquebec.gouv.qc.ca

Actrespectinghealthservicesandsocialserviceswww2.publicationsduquebec.gouv.qc.ca

Ministère de la Santé et des Services sociauxwww.masantementale.gouv.qc.ca

Regroupement des ressources alternatives en santé mentale du Québecwww.rrasmq.com

Revivrewww.revivre.org

List of acronyms

Appendix 3


LIST OF ACRONYMS

CHA Centre hospitalier affilié universitaire de Québec

CHUQ Centre hospitalier universitaire de Québec

CLSC Centre local de services communautaires

CSSS Centre de santé et de services sociaux

FFAPAMM Fédération des familles et amis de la personne atteinte de maladie mentale

FMG FamilyMedicineGroup

MSSS Ministère de la Santé et des Services sociaux

PASM Plan d’action en santé mentale 2005-2010 – La force des liens

45Bibliography

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MINISTÈREDELASANTÉETDESSERVICESSOCIAUX.Pland’actionensantémentale2005-2010–Laforcedesliens,Québec,ministèredelaSantéetdesServicessociaux,2005

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THORNTON,JOHNF.etal.Laschizophrénie–Symptômesettraitementàdomicile,designedbyMarionMerrellDowprofessionalservices,2005

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47Note

NOTES

COORDINATION AND PRODUCTION Communication Department, Institut universitaire en santé mentale de Québec

Credits for cover page art work:Sierra Nevada, painting by Benoît Genest-RouillerVincent et moi CollectionInstitut universitaire en santé mentale de Québec

We would like to thank the following for their generous financial contributions:• Ministère de la Santé et des Services sociaux• Fondation Robert-Giffard• Comité des usagers de l’Institut universitaire en santé mentale de Québec• Comité des usagers du Centre hospitalier affilié universitaire de Québec (CHA) • Fondation du Centre hospitalier universitaire de Québec (CHUQ)• Comité des usagers du CHUQ

Printed on recycled paper containing 50% post-consumption fibres

Soutien aux proches d’une personne atteinted’un trouble majeur de santé mentale ou de maladie mentale

© Institut universitaire en santé mentale de Québec, february 2012.

Order additionnal copies on line:http://www.institutsmq.qc.ca/publications/

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