La présence et la gravité des troubles de santé mentale sont-elles liées à la nature de la crise, à la dangerosité et aux services de crise offerts ?

Résumé Fr En

Au Québec, les centres de crise ont été développés dans le contexte de la désinstitutionnalisation, ce qui a mené à une offre de services devant répondre aux besoins d’une clientèle hétérogène. À ce jour, encore peu d’études ont décrit et comparé les profils cliniques des personnes qui effectuent une demande d’aide à un centre de crise en considérant la présence ou non d’un trouble de santé mentale et la nature de celui-ci. Les dossiers de 1170 nouveaux demandeurs de services au Centre d’aide 24/7 ont été examinés rétrospectivement. Parmi ces demandeurs, 48 % souffraient d’un trouble de santé mentale et, de ceux-ci, 9 % rapportaient un trouble mental grave, soit un trouble psychotique ou bipolaire. Les résultats indiquent que le fait d’avoir un trouble de santé mentale est associé à une probabilité plus élevée de rapporter des événements stressants à caractère interpersonnel, une crise plus intense ainsi que des comportements auto-agressifs. Les personnes ayant un trouble psychotique ou bipolaire sont quant à elles plus fréquemment hébergées et plus susceptibles de recevoir des services intensifs et encadrants. Il semble donc que la présence et le type de troubles de santé mentale des demandeurs d’aide en centre de crise permettent non seulement de mieux anticiper la nature et l’intensité de la crise mais aussi le type de services requis.

The mandate of crisis centres varies substantially from one country to the next according to the government policies in effect. In the United States, crisis centres were developed based on Caplan’s theory, which defines crisis as a psychosocial disorganization following a life event that is resolved with a return to balance. This approach aims at preventing the onset of mental health disorders through short-term intervention. It is different in Quebec, where crisis centres were developed in a deinstitutionalization context and ought to constitute an alternative to hospitalisation. Such mandate of Quebec crisis centres is not necessarily of the preventive nature associated with Caplan’s theory and it has led to services having to be adapted to a heterogeneous clientele that may or may not suffer from mental health problems. It has implications related to the crisis characteristics such as its nature, intensity, and dangerosity, as well as implications regarding the organization of crisis centre services, which have been the object of few studies so far. Objective: The present study aims at distinguishing clinical profiles of crisis centre callers according to the presence or absence of a mental health disorder and its nature, that is severe and persistent (psychotic or bipolar disorder) or not (mood, anxiety or personality disorder). In order to do so, participants are compared on the characteristics of the crisis and the services they received. Method: In this descriptive study, the files of 1170 new assistance applicants are retrospectively analyzed based on a predetermined grid that was used to collect data according to the main clinical characteristics of persons in distress, as recognized in the literature. The subgroup of persons presenting a psychotic or bipolar disorder was examined separately from the one comprising persons with an anxiety, mood or personality disorder because of its clinical complexity, which generally requires intensive, multidisciplinary follow-up. Results: Among the new applicants, 48% had a mental health disorder and, of these, 9% reported a serious mental health disorder, that is, a psychotic or bipolar disorder. The results indicate that having an anxiety-, mood- or personality-type disorder is associated with a higher probability of reporting stressful interpersonal-type events, a more intense crisis, as well as a greater risk of auto-aggressive behaviours. Meanwhile, persons with a psychotic or bipolar disorder are more frequently provided with accommodations and more likely to receive intensive and support services, such as emergency interventions or the use of the Act respecting the protection of persons whose mental state presents a danger to themselves or others (P-38). Conclusions: This descriptive portrait of the crisis centre clientele contributes to the reflection on differential intervention with persons in a crisis situation. It appears important to take an interest in the presence and type of mental health disorders of crisis centre callers, since these characteristics help to better foresee not only the nature and intensity of the crisis but also the type of services required. However, Quebec crisis centres have to respond to the needs of a heterogeneous clientele without having access to a typology and a theoretical model that consider this clinical diversity. Other studies should be conducted to validate, on the one hand, a crisis typology that would make it easier for caseworkers to collect data for evaluation purposes and, on the other hand, a differential intervention model.