This qualitative study examined the delivery of Assertive Community Treatment from the perspective of service providers of 4 ACT teams in southeastern Ontario. Overall, providers were positive about their involvement with ACT. Eight tensions experienced in the context of delivering services emerged: negotiating governance structures; providing 24-hour coverage; balancing the clinical-administrative responsibilities of team leaders; accessing hospital beds; meeting local population needs; integrating treatment and rehabilitation; changing services to meet changes in the population being served; and implementing ambiguous ACT standards. Framing these challenges in the context of ACT structures and the broader community mental health system, the study suggests possibilities for the ongoing development of the model to facilitate the realization of the ACT vision.

The integration of treatment and psychiatric rehabilitation in mental health services is challenging to realize but essential for a mental health system that has endorsed recovery as its guiding vision. This paper advocates the use of tensions in practice as a means of reconciling integration issues and advancing recovery-oriented service delivery. The paper follows with three scenarios of daily tensions in practice that serve as a foundation for analyzing and ultimately reconciling tensions in integration. Finally, six guidelines covering a range of organizational, administrative, financial, and service delivery perspectives are provided to guide the development of integrated treatment and rehabilitation toward a recovery-oriented system.

Voices, Opportunities & Choices Employment Club (VOCEC) is a nonprofit “umbrella” corporation that facilitates the development of affirmative businesses to create jobs for consumers of mental health services. To date, 5 independent businesses have been developed by transforming the resources of sheltered workshops within Kingston Psychiatric Hospital and 2 businesses have been established in collaboration with a local public library. This paper provides a description of VOCEC, including an overview of the affirmative business approach, the structure of the organization, and the process of business development. Personal reflections provide insights into the experiences of consumers, staff, and Board members associated with the corporation.

This research study portrays work initiatives for persons with serious mental illness in Canada. It considers 2 earlier papers on vocational programs and services to point out developments and current status in the field. Through a content analysis of documents collected from work initiatives across Canada, core values, models, and practices in the area of work integration are presented. Findings point to a consistent belief in the capacity of consumers to develop their work potential, to engage in the labour force, and to experience the many benefits of work. Results also reveal evidence of an increased emphasis on consumer initiatives, partnerships within the community, and negotiation of environmental factors, including workplace accommodations. Examples of work initiatives are provided, and suggestions for further research are offered.

Introduction: Military family life is characterized by mobility, separation, and increased risk for injury or death of the military member, which impacts the health and well-being of all family members. Additional stress is experienced when accessing and navigating a new health care system. Unknown to most Canadians is the reality that military and Veteran families (MVFs) access the civilian health care system; this indicates a need for military family cultural competency among health care providers. This current research identifies aspects of military family cultural competency to inform health care provision to MVFs. Method: A qualitative study using one-on-one interviews was completed with MVFs. Critical Incident Technique (CIT) was used to develop interview questions. Framework analysis was used for data analysis. Results: In total 17 interviews were completed including:1 family (female military spouse, male military member and child); 1 male Veteran; and 15 female military spouses (1 Veteran; 1 active member). Military family cultural competency domains such as cultural knowledge (characteristics of military families; impacts of mobility, separation, and risk) and cultural skills (building relationships; use of effective and appropriate assessments and interventions) were identified. The ecological context was also described as impacting the health care experience. Discussion: The reported experiences of MVFs in this study have highlighted the gaps in the military family cultural knowledge and military family cultural skills Canadian health care providers have when providing care. Results of this study can be used to develop continuing education for health professionals and inform future research.