This article describes the work of the legislation subcommittee of the steering committee responsible for the implementation of the Graham Report, Ontario's current blueprint for community mental health. It describes barriers to psychiatric survivor participation in the subcommittee's 1990 provincial consultation, including professional/bureaucratic characterization of survivor actions during the event as "bad manners." I argue that this naming is an act of power. Conflicts arose because the two groups operate from different behavioural codes in which the pivotal issue, acted out indirectly in all kinds of interactions, was whether and how deeply to include personal experience and emotions as forms of knowledge. The cultural dimensions of "consumer participation" must be more broadly recognized and more consciously considered if this policy is to remain viable, particularly in a time of major economic restructuring.
Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.
The evolution of the Haida Gwaii Diabetes Project exemplifies how community-based family practice research can be a tool for empowerment for both the community of research participants and the community based members of the research team. The aims of the project are to develop a better understanding of Haida beliefs about diabetes; to develop culturally sensitive approaches to prevention and management; and to attempt to apply this understanding to the development of a model for preventive health for native people in the province of British Columbia. A participatory research paradigm, coupled with explicit working principles by which the research team agreed to operate, addressed the concerns that the Aboriginal community had about the risks of research. A true working partnership has developed among all members of the research team, and with the Haida community.
Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature. This paper provides background information on the historical origins of community development work through an extensive review of the literature. As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science. These include economic development models, education models both formal and informal, confrontational models, and empowerment models. Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health. However, much additional work will be needed to test out models for community development in actual practice. Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population.
In this paper, we explore 3 diverse populations: street kids, political prisoners, and caregivers of people with HIV/AIDS. From these explorations, we consider the concepts of empowerment, resilience, and community-building. By interweaving these 3 key concepts, we develop a cyclical wellness model which can be applied equally to individuals and communities. This model highlights the strengths of individuals and communities and will, we believe, provide a critical element of hope to societies within our increasingly global economy.
In order to achieve true community participation in mental health care, a redistribution of decision-making power is needed. Currently, this power is almost exclusively in the hands of psychiatric institutions and the state. Community participation would require greater representation from community organizations. This paper describes the history of the alternative resources movement in Quebec. This movement has challenged the health care system and promoted innovative therapeutic approaches. In this process, community organizations have been faced with the difficult task of gaining more power while maintaining strong links with the communities they serve.
Since the beginning of the 1970s, the province of Quebec has undergone a major reform of its health and social services system. Following this reform, the state has become a major protagonist, and the participation of the population is a built-in element in the system, guaranteed by law. Now, about 20 years later, there is a major effort to reorganize health services, in the wake of a "dewelfarization" mood that has reached Canada and Quebec. This article reviews the successes and pitfalls of public participation in Quebec's health system, presents the way in which participation is dealt with in current reform proposals, and draws lessons for people in many countries who have recently been encouraged to jump onto the bandwagon of participation as a strategy to promote the health of populations.