Assistance offered in the public system
The CISSS-CIUSSS have a range of programs and services available to people living with a mental health problem or disorder. The following list is not exhaustive and some of the services are not available in all regions of Quebec. Programs and services are also sometimes offered by the network of community organizations specializing in mental health and, more rarely, by the private network.
Medication
In order to promote medical follow-up in the community of the person living with a stabilized mental health problem or disorder, a sponsoring psychiatrist advises general practitioners. The family physician can therefore adjust or renew medication if necessary or refer the person to resources that can help him or her.
Agreeing or not agreeing to take medication can become an important issue for the person who has been prescribed pills. Medication can totally or partially reduce the symptoms and effects of the mental health problem for many people. However, for some people, side effects are not always easy to control and the absence of initial symptoms may cause the person to stop taking the medication. Abruptly stopping medication can have serious consequences.
In the 1990s, a research team and community organizations developed an alternative approach to Medication Self-Management (MSM):
The goal of Medication Self-Management in Mental Health is to enable the person taking medication to move closer to a medication that is appropriate for him or her and that is part of a larger process of improvement, wellness and empowerment in his or her life. It involves access to all the necessary information regarding medication and alternatives.
The Mental Health Action Plan 2015-2020 also mentions this.
Psychotherapies
In front-line mental health services, very short-term psychotherapy services are offered, most of the time to accompany the person in his or her evolution in the face of the problem that brought him or her to consult. This could be individual, couple and family therapy. Information on the disease, its treatments, medication and self-management support on how to help oneself can also be offered.
The Ministère de la Santé et des Services sociaux is following the work done by the Institut national d’excellence en santé et en services sociaux (INESSS) on the various models for improving access to psychotherapy services and the funding modalities to be implemented for this purpose.
Hospitalization
Hospitalization is sometimes necessary to allow the person to recover sufficiently. To stabilize the person’s condition, in some situations medication may be used and time may be needed to see the positive or negative effects. A variety of therapeutic activities are offered to help the person begin or maintain recovery goals.
Outpatient Psychiatric Clinic
The Psychiatric Outpatient Clinic provides psychiatric assessments, consultations and follow-ups. It also handles more complex cases.
Support of varying intensity
Variable Intensity Support (VIS) is intended for people with severe mental health problems, but whose level of difficulty is generally less than that of the people targeted for intensive follow-up, although this does not exclude periods of great fragility. The clientele served has rehabilitation and support needs.
Intensive follow-up in the community
Intensive follow-up is intended for people with severe mental illness whose condition is unstable and fragile. This follow-up is a very structuring measure aimed at maintaining them in the community. This service is intended for clients with treatment, rehabilitation and support needs.
Residential service
Different types of transitional, medium or long-term accommodation may be offered to the person who does not have the autonomy to live alone or with a family. These may be supervised apartments, shared apartments or family-type or intermediate resources such as drop-in centres. Many accommodations are also offered by community organizations.
Specialized services
Some CISSS-CIUSSS offer specialized services around a theme. Here is an (incomplete) list of these services, which allows you to see the scope of the problems addressed:
Alzheimer’s and other forms of dementia
Intellectual disability with psychopathology
Depression
Gerontopsychiatry
Forensic Psychiatry
Perinatal Psychiatry
Psychiatry and addiction
Psychosomatic
Sleep
Anxiety and mood disorders (including bipolar disorder)
Eating disorders
Sexual Behavioural Disorders
Autism Spectrum Disorders
Psychotic disorders (including schizophrenia)
Relationship disorders
Severe personality disorders
Mobile Crisis Assessment Team
First Episode Psychotic Intervention Program (FEPIP)
Justice and Mental Health Support Program
Socio-Professional Integration Program
Homelessness and Mental Health Program
The CISSS-CIUSSS also offers specialized child psychiatry services that reach children with problems when they are identified at an early age.
What kinds of psychotherapy could help me?
There are many theoretical approaches to help people regain psychological well-being. Some are recognized while others are still being evaluated or have not proven their usefulness. We will come back to this a little later.
Psychotherapist
Above all, let’s look at people who call themselves psychotherapists, knowing that there are also impostors, people who improvise, incompetents, profiteers, people who believe that their personal experience applies to everyone…. In the media, there are sometimes tragic stories of vulnerable people who have been cheated in their search for help. An Act to amend the Professional Code and other legislative provisions in the field of mental health and human relations was adopted to clarify, as best as possible, the actions taken in various types of interventions in the mental health field. Thus, a person who claims to be a psychotherapist without being a psychologist or physician must hold a permit issued by the Ordre des psychologues recognizing his or her competence. The Regulation under the Professional Code clearly describes the criteria required to be qualified.
On the site of the Ordre des psychologues, the following definition of psychotherapy can be found:
“Psychological treatment for a mental disorder, behavioural disturbance or any other problem resulting in psychological suffering or distress that is intended to bring about significant changes in the client’s cognitive, emotional or behavioural functioning, interpersonal system, personality or health status. This treatment goes beyond helping to cope with common difficulties or providing advice or support. »
And to clarify roles, the regulations specify other types of intervention that may have a therapeutic impact but are not psychotherapy:
The accompaniment meeting aims to support the person through meetings, which may be regular or punctual, allowing the person to express himself or herself on his or her difficulties. In such a setting, the professional or intervener can provide advice or make recommendations.
The support intervention aims to support the person in order to maintain and consolidate what has been learned and adaptation strategies by targeting strengths and resources through regular or one-time meetings or activities. This intervention involves reassuring, giving advice and providing information related to the person’s condition or the situation being experienced.
Conjugal and family intervention aims to promote and support the optimal functioning of the couple or the family by means of interviews often involving all of its members. Its goal is to change elements of conjugal or family functioning that hinder the development of the couple or family members, or to offer help and advice in order to deal with everyday difficulties.
Psychological education aims at learning by informing and educating the person. It can be used at all stages of the care and service process. It involves the teaching of specific knowledge and skills aimed at maintaining and improving the person’s autonomy or health, in particular to prevent the appearance of health or social problems including mental disorders or deterioration of mental state. For example, instruction may focus on the nature of physical or mental illness, its manifestations, its treatments, including the role that the person can play in maintaining or restoring his or her health, and also on stress management, relaxation or assertiveness techniques.
Rehabilitation aims to help the person cope with the symptoms of an illness or improve his or her skills. It is used, among other things, with people suffering from significant mental health problems in order to help them achieve an optimal degree of autonomy with a view to recovery. It can be used in the context of accompaniment or support meetings and include, for example, hallucination management and training in daily and social skills.
Clinical follow-up consists of meetings to update a disciplinary intervention plan. It is intended for the person who presents behavioural disturbances or any other problem leading to suffering or psychological distress or health problems including mental disorders. It may involve the contribution of various professionals or interveners grouped in interdisciplinary or multidisciplinary teams. This follow-up may be part of an intervention plan within the meaning of the Act respecting health services and social services (R.S.Q., c. S-4.2) or the Education Act (R.S.Q., c. I-13.3), take place in the context of support meetings or support interventions and may also involve rehabilitation or psychological education. It may also involve adjustment of pharmacotherapy.
Coaching aims at realizing the potential, through the development of talents, resources or skills of a person who is neither in distress nor suffering, but who expresses particular needs in terms of personal or professional fulfillment.
Crisis intervention consists of an immediate, brief and directive intervention that is modulated according to the type of crisis, the characteristics of the person and those of his or her entourage. It aims to stabilize the state of the person or his or her environment in relation to the crisis situation. This type of intervention may involve exploring the situation and estimating the possible consequences, for example, the potential for dangerousness, suicidal risk or risk of decompensation, defusing the situation, providing support, teaching coping strategies to deal with the situation experienced, and referring the person to the most appropriate services or care.
Quebec’s community, public and private mental health networks offer different means depending on the approaches, programs or activities offered to the person living with a mental health problem or disorder.
Finding psychotherapy
As for psychotherapy, the Ordre des psychologues has 8,734 members who work mainly in the private and public networks (health, school, legal, research and others). Of this group, 2,981 work exclusively in the private sector. In addition, members of the following professional orders may have applied for a psychotherapist’s permit:
There is also the Association des psychothérapeutes du Québec which can be a source for finding a licensed psychotherapist. When the Act to amend the Professional Code was adopted, a clause of acquired rights allowed persons who are not members of a professional order, while having demonstrated competence, to obtain the title of psychotherapist. His or her name will appear on the site of persons authorized by the Ordre des psychologues..
Access to psychotherapy in the community network is often free or, when there is a fee, it is modulated according to the person’s income. Few organizations offer therapy and they are in demand! Access to psychotherapy in the public network is free. Meetings are often limited to a short period of time. The ministry is studying the possibility of broadening access and the duration of psychotherapeutic approaches. The community and the public offer most of the other types of intervention mentioned above (accompaniment, support, etc.).
People who have access to health insurance with their employment can receive an amount for psychological assistance during a certain number of meetings. In large companies, there is sometimes support offered by the human resources department as part of employee assistance programs.
Ultimately, it will be meetings to be paid for with professional people (approximately $80 to $130, the amount can vary and is not regulated). The amounts paid will be eligible as medical expenses for tax deduction.
Therapeutic approaches
On the site of the Ordre des psychologues, you will find information on the four major schools of thought, which are called “theoretical orientations”.. These are four different ways of looking at psychotherapy, each of which is equally valid and effective. The majority of psychologists and psychotherapists are guided by principles from different orientations.
Cognitive-behavioural orientation is based on the idea that psychological difficulties are related to inappropriate thoughts or behaviours. The psychotherapist who adopts this approach uses different techniques and strategies to help his client change his behaviours, thoughts and emotions.
According to the existential-humanistic orientation, the human being has within him or herself the necessary resources to achieve self-fulfillment. The humanist psychotherapist seeks to help the person become aware of his or her difficulties, understand them and make his or her own decisions in order to act according to who he or she is and how he or she feels.
Strongly influenced by psychoanalysis and using the notion of the unconscious, the psychodynamic-analytical orientation establishes a link between the client’s current difficulties, past experiences and the repressed and unresolved conflicts of his or her personal history. The person is led to become aware of the influence of these conflicts on his functioning in order to understand them and gradually emerge from them.
In the systemic-interaction orientation, we consider that personal problems arise and are maintained because of the interaction between a person and his or her environment. The goal of systemic psychotherapy is to change the relationship between the person and his or her environment. It is therefore common for psychotherapists to meet with people who are significant to their clients.
Psychotherapists may also use a medium (painting, writing, an animal such as a horse, for example), offer group approaches, or specialize in particular problems or situations…
Regardless of the approaches and ways of doing things, the creation of a helping relationship presupposes that the person living with a mental health problem or disorder is able to feel confident with the professional offering his or her services. This trust is all the more important because psychotherapy requires efforts, sometimes difficult, to get the person being helped to change elements in his or her way of life.