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Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves : perspectives d’intervenants psychosociaux*

Published online by Cambridge University Press:  27 April 2010

Bernadette Dallaire ,
Michael McCubbin ,
Mélanie Provost ,
Normand Carpentier  and
Michèle Clément
Bernadette Dallaire*
Affiliation:
Professeure agrégée, École de Service social, Université Laval, Québec
Michael McCubbin
Affiliation:
Professeur associé, École de Service social, Université Laval, Québec
Mélanie Provost
Affiliation:
Agente de recherche, GRIOSE-SM, Centre de santé et de services sociaux de la Vieille-Capitale/Centre de recherche Université Laval - Robert-Giffard, Québec
Normand Carpentier
Affiliation:
Chercheur, Institut universitaire de gériatrie de Montréal, Université de Montréal
Michèle Clément
Affiliation:
Chercheure, GRIOSE-SM, Centre de santé et de services sociaux de la Vieille-Capitale/Centre de recherche Université Laval - Robert-Giffard, Québec
*
†Adresse de correspondance: Bernadette Dallaire École de Service social Pav. Charles-De Koninck Université Laval Québec, Qc, G1V 0A6. Tel.: (418) 656-2131, poste 12899; télécopieur: (418) 656-3567 Courriel: (bernadette.dallaire@svs.ulaval.ca)
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Abstract

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to “double stigmatization” targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.

Résumé

Les services offerts aux aînés aux prises avec des troubles mentaux graves (TMG) présentent des lacunes importantes, notamment le manque de services psychosociaux adéquats. Certains ont attribué cette situation à une « double stigmatisation » visant à la fois le vieillissement et la maladie mentale. À partir d’une démarche exploratoire fondée sur des méthodologies qualitatives (23 entrevues semi-dirigées, analyse de contenus thématique), notre recherche vise notamment à mieux connaître les perceptions des intervenants psychosociaux des milieux institutionnels et communautaires sur les personnes âgées atteintes de TMG et sur leurs situations de vie. Les intervenants font état de situations de vie marquées par le manque de soutien (isolement), le manque de ressources (précarité/pauvreté) et le manque de pouvoir (passivité acquise), des traits qui seraient liés non seulement à la maladie mentale elle-même, mais aussi à l’institutionnalisation psychiatrique à long terme. Pour eux, la situation actuelle des aînés avec TMG constitue l’aboutissement d’un parcours où histoire de vie, histoire de maladie et histoire dans les services et/ou les institutions se rejoignent et quelquefois se confondent. Les implications de ces résultats pour la pratique psychosociale sont discutées.

Keywords

personnes âgéestroubles mentaux gravesintervenants psychosociauxelderlysevere mental disorderspsychosocial practitioners
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 29 , Issue 2 , June 2010 , pp. 267 - 279
Copyright
Copyright © Canadian Association on Gerontology 2010

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Footnotes

*

Les auteurs tiennent à remercier les intervenantes et intervenants ayant participé à la recherche dont les résultats sont présentés ici, ainsi que les organisations qui ont soutenu leur participation. Ils remercient également le Conseil de la recherche en sciences humaines du Canada pour son appui financier à cette étude, dont le présent article constitue l’une des retombées.

References

Références Bibliographiques

Bartels, S. J. (2003). Improving the system of care for older adults with mental illness in the United States. Findings and recommendations for the President’s New Freedom Commission on Mental Health. American Journal of Geriatric Psychiatry, 11, 486–497.Google Scholar
Bartels, S. J., Forester, B., Mueser, K.T., Miles, K. M., Dums, A. R., Pratt, S. I., et al. (2004). Enhanced skills training and health care management for older persons with severe mental illness. Community Mental Health Journal, 40, 75–90.Google Scholar
Bartels, S. J., Levine, K. & Shea, D. (1999). Community-based long-term care for older persons with severe and persistent mental illness in an era of managed care. Psychiatric Services, 50, 1189–1197.CrossRefGoogle Scholar
Bronskill, S. E., Anderson, G. M., Sykora, K., Wodchis, W. P., Gill, S., Shulman, K. I., et al. (2004). Neuroleptic drug therapy in older adults newly admitted to nursing homes: Incidence, dose, and specialist contact. Journal of the American Geriatric Society, 52, 749–755.CrossRefGoogle ScholarPubMed
Butler, R. N. (1975). Psychiatry and the elderly: An overview. American Journal of Psychiatry, 132, 893–900.Google ScholarPubMed
Chiu, E., Yastrubetskaya, O., & Williams, M. (1999). Psychosocial rehabilitation of elderly with mental disorders: A neglected area in the psychiatry of old age Current Opinion in Psychiatry, 12, 445–447.Google Scholar
Clément, M. (2001). L’exclusion des personnes atteintes de maladie mentale: Ancienne problématique, nouvelles réalités. In Dorvil, H. & Mayer, R. (Eds.), Problèmes sociaux, Tome 1: Théories et méthodologies (489–509). Québec, Québec, Canada: Presses de l’Université du Québec.Google Scholar
Coalition canadienne pour la santé mentale des personnes âgées/Canadian Coalition for Seniors’ Mental Health. (2006). National guidelines for seniors’ mental health. The assessment and treatment of mental health issues in long-term care homes (focus on mood and behaviour symptoms). Toronto, Ontario, Canada: Canadian Coalition for Seniors’ Mental Health.Google Scholar
Cohen, C. I. (1990). Outcome of schizophrenia into later life: An overview. The Gerontologist, 30, 790–797.Google Scholar
Cohen, C. I. (2000). Directions for research and policy on schizophrenia and older adults: Summary of the GAP Committee report. Psychiatric Services, 51(3), 299–302.CrossRefGoogle Scholar
CSSS de la Vieille-Capitale, services d’hébergement et de soins de longue durée. (2007). Résultat de la compilation par site—Santé mentale. [Document] (série de tableaux). Québec: CSSS de la Vieille-Capitale.Google Scholar
Dallaire, B., & McCubbin, M. (2008). Parlons d’inclusion sociale. La théorie et la recherche à propos des personnes aux prises avec des handicaps psychosociaux. In Gagnon, E., Pelchat, Y. & Édouard, R. (Eds.), Politiques d’intégration, rapports d’exclusion (pp. 251–266). Québec, Québec, Canada: Les Presses de l’Université Laval.Google Scholar
Dallaire, B., Miranda, D., Moscovitz, N., & Guérette, A. (2003). Les interventions communau-taires auprès des personnes âgées aux prises avec des troubles mentaux graves: Revue critique de la littérature empirique et théorique. Rapport soumis au Fonds québécois sur la société et la culture. Québec, Québec, Canada: Bibliothèque nationale du Québec (ISBN: 2-9807929-X).Google Scholar
Depla, M., Pols, J., de Lange, J., Smits, C. H. M., de Graaf, R. & Heeren, T. J. (2003). Integrating mental health care into residential homes for the elderly: An analysis of six Dutch programs for older people with severe and persistent mental illness. Journal of the American Geriatrics Society, 51(9), 1275–1279.CrossRefGoogle ScholarPubMed
Dorvil, H. & Benoit, M. (1999). Représentations sociales et conditions de vie des personnes âgées classées malades mentales ou déficientes intellectuelles en résidence d’accueil. Santé mentale au Québec, 14, 228–252.Google Scholar
Estes, C. L., & Biney, E. A. (1991). The biomedicalization of aging: Dangers and dilemmas. In Minkler, M. & Estes, C. L. (Eds.), Critical perspectives of aging: The political moral economy of growing old (pp. 117–134). New York: Baywood.Google Scholar
Fenton, J., Raskin, A., Gruber-Baldini, A., Srikumar Menon, A., Zimmerman, S., Kaup, B., et al. (2004). Some predictors of psychiatric consultation in nursing home residents. American Journal of Geriatric Psychiatry, 12, 297–304.Google Scholar
Goldlist, B. (2000). Mental health management is no waste of clinical acumen: Prognosis for elderly patients is as favourable as for younger ones. Geriatrics and Aging, 3(4). Retrieved March 30, 2010, from http://www.geriatricsandaging.caGoogle Scholar
Goldman, H. H., & Manderscheid, R. W. (1987). Epidemiology of chronic mental disorders. In Menninger, W. W. & Hannah, G. (Eds.), The chronic mental patient (Vol. 2). Washington, DC: American Psychiatric Press.Google Scholar
Grant, L. D. (1996). Effects of ageism on individual and health care providers’ response to healthy aging. Health & Social Work, 21, 9–15.CrossRefGoogle ScholarPubMed
Herrick, C. A., Pearcey, L. G., & Ross, C. (1997). Stigma and ageism: Compounding influences in making an accurate mental health assessment. Nursing Forum, 32(3), 21–26.Google Scholar
Holmes, J., Bentley, K., & Cameron, I. (2003). A UK survey of psychiatric services for older people in general hospitals. International Journal of Geriatric Psychiatry, 18, 716–721.CrossRefGoogle ScholarPubMed
Kindiak, D. H., Grieve, J. L., Randall, G. E. & Madsen, V. A. (2004). Social work practice in community psychogeriatric programs. In Holosko, M. J. & Feit, M. D. (Eds.), Social work practice with the elderly (519–545). Toronto, Ontario, Canada: Canadian Scholars’ Press.Google Scholar
Kirby, M. J. L., & Keon, M. J. (2006). De l’ombre à la lumière. La transformation des services concernant la santé mentale, la maladie mentale et la toxicomanie au Canada. Rapport du Comité sénatorial permanent des affaires sociales, des sciences et de la technologie. Ottawa, Ontario, Canada: Sénat du Canada.Google Scholar
Lagana, L. & Shanks, S. (2002). Mutual biases underlying the problematic relationship between older adults and mental health providers: Any solution in sight? International Journal of Aging and Human Development, 55(3), 271–295.Google Scholar
Larivière, N., Gélinas, B., Tallant, B. & Paquette, I. (2006). Adjustment to community residential settings over time among older adults with serious mental illnesses. Psychiatric Rehabilitation Journal, 29(3), 189–196.Google Scholar
Mackenzie, C. S., Gekoski, W. L. & Knox, V. J. (1999) Do family physicians treat older patients with mental health disorders differently from younger patients? Le médecin de famille canadien, 45, 1219–1224.Google Scholar
Matteau, H. (2008). Comment gérer les problèmes de comportement dans un centre d’hébergement en regroupant les résidents selon leurs profils cliniques. Transphère. L’exploration des sphères d’activité du Centre de santé et de services sociaux de la Vieille-Capitale, 4(2), 10–12.Google Scholar
Mayer, R., Ouellet, H., Saint-Jacques, M.-C. & Turcotte, D. (2000). Méthode de recherche en intervention sociale. Montréal, Quebec, Canada: Gaëtan Morin éditeur.Google Scholar
Meeks, S., & Murrell, S. A. (1997). Mental illness in late life: Socioeconomic conditions, psychiatric symptoms, and adjustment of long-term sufferers. Psychology and Aging, 12, 296–308.CrossRefGoogle ScholarPubMed
Mendonça Lima, C. A., Levav, I., Jacobsson, L. & Rutz, W; World Health Organi-zation/European Regional Office, Task Force on Destigmatization. (2003). Stigma and discrimination against older people with mental disorders in Europe. International Journal of Geriatric Psychiatry, 18, 679–682.CrossRefGoogle ScholarPubMed
Ministère de la Famille et de l’Enfance. (2001). Le Québec et ses aînés: engagés dans l’action. Engagements et perspectives 2001-2004. Québec, Québec, Canada: Gouvernement du Québec.Google Scholar
Mosher-Ashley, P. M., Turner, B. F. & O’Neill, D. (1991). Attitudes of nursing and rest home administrators toward deinstitutionalized elders with psychiatric disorders. Community Mental Health Journal, 27(4), 241–253.CrossRefGoogle ScholarPubMed
National Institute for Mental Health in England. (2005). Facts for champions. London: Department of Health. Retrieved March 31, 2009, from http://kc.nimhe.org.uk/upload/keyfacts12[1][1].4.5withlogos.docGoogle Scholar
Onken, S., Dumont, J. M., Ridgway, P., Dornan, D. H. & Ralph, R. O. (2002). Mental health recovery: What helps and what hinders? A national research project for the development of recovery facilitating system performance indicators. Rapport préparé pour le National Technical Assistance Center for State Mental Health Planning, National Association of State Mental Health Program Directors (NASMHPD). Washington, DC: NASMHPD.Google Scholar
Osgood, N. J. (1992). Suicide in later life: Recognizing the warning signs. New York: Lexington.Google Scholar
Palmer, B. W., Heaton, S. C., & Jeste, D. V. (1999). Older patients with schizophrenia: Challenges in the coming decades. Psychiatric Services, 50(9), 1178–1183.Google Scholar
Provencher, H. L. (2002). L’expérience du rétablissement: Perspectives théoriques. Santé mentale au Québec, 1, 35–64.Google Scholar
Ragan, A. M., & Bowen, A. M. (2002). Improving attitudes regarding the elderly population: The effects of information and reinforcement for change. The Gerontologist, 41, 511–515.CrossRefGoogle Scholar
Robins, L. N. & Regier, D. A. (Eds.). (1991). Psychiatric disorders in America: The epidemiologic catchment area study. New York: Free Press.Google Scholar
Royal College of Psychiatrists. (2005). Caring for people who enter old age with enduring or relapsing mental illness. London: Royal College of Psychiatrists Council Report CR110.Google Scholar
Social Care Institute for Excellence. (2006). Practice guide 3: Assessing the mental health needs of older people. London (UK): Social Care Institute for Excellence. Retrieved March 2, 2009, from http://www.scie.org.uk/publications/practiceguides/practiceguide02/index.aspGoogle Scholar
Talbott, J.A. (2002). Deinstitutionalization: Avoiding the disasters of the past. Psychiatric services, 55(10), 1112–1115.Google Scholar
Thompson, R. (1999). Home care of the elderly with mental health needs. Nursing Times, 95(10), 10–16, 48–49.Google Scholar
Tuokko, H., MacCourt, P. & Milliken, J. (2008). Understanding the needs of caregivers of mentally ill older adults: Hearing their voices to inform services. Victoria, Canada: University of Victoria Centre on Aging.Google Scholar
United States Department of Health and Human Services—Substance Abuse and Mental Health Services Administration. (2004). Community integration for older adults with mental illnesses: Overcoming barriers and seizing opportunities. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.Google Scholar
Voyer, P., McCubbin, M., Préville, M. & Boyer, R. (2003). Factors in duration of anxiolytic, sedative and hypnotic use by elderly, and implications for nursing. Canadian Journal of Nursing Research, 35, 126–149.Google Scholar