A qualitative study on the ethics of transforming care: examining the development and implementation of Canada's first mental health strategy.
BACKGROUND
The Mental Health Commission of Canada worked collaboratively with stakeholders to create a new framework for a federal mental health strategy, which is now mandated for implementation by 2017. The proposed strategies have been written into provincial health plans, hospital accreditation standards, and the annual objectives of psychiatric departments and community organizations. This project will explore the decision-making process among those who contributed to Canada's first federal mental health policy and those implementing this policy in the clinical setting. Despite the centrality of ethical reasoning to the successful uptake of the recent national guidelines for recovery-oriented care, to date, there are no studies focused exclusively on the ethical tensions that emerged and continue to emerge during the creation and implementation of the new standards for recovery-oriented practice.


METHODS
This two-year Canadian Institute of Health Research Catalyst Grant in Ethics (2015-2017) consists of three components. C-I, a retrospective, qualitative study consisting of document analysis and interviews with key policy-makers of the ethical tensions that arose during the development of Canada's Mental Health Strategy will be conducted in parallel to C-II, a theory-based, focused ethnography of how mental health practitioners in a psychiatric setting reason about and act upon new standards in everyday practice. Case-based scenarios of ethical tensions will be developed from C-I/II and fed-forward to C-III: participatory forums with policy-makers, mental health practitioners, and other stakeholders in recovery-oriented services to collectively identify and prioritize key ethical concerns and generate action steps to close the gap between the policy-making process and its implementation at the local level.


CONCLUSIONS
Policy-makers and clinicians make important everyday decisions that effect the creation and implementation of new practice standards. Particularly, there is a need to understand how ethical dilemmas that arise during this decision-making process and the reasoning and resources they use to resolve these tensions impact on the implementation process. This catalyst grant in ethics will (1) introduce a novel line of inquiry focusing on the ethical tensions that arose in the development of Canada's first mental health strategy, while (2) intensifying our focus on the ethical aspects of moving policy into action.
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3600 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada. melissa.park@mcgill.ca.|Participatory Research at McGill, McGill University, Montreal, QC, H3S 1Z1, Canada. melissa.park@mcgill.ca.|Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, H3T 1E2, Canada. melissa.park@mcgill.ca.
Melissa M
MM
Park
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3600 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada. raphael.lencucha@mcgill.ca.
Raphael
R
Lencucha
Department of Anthropology and the Division of Occupational Science and Therapy, University of Southern California, 3620 S. Vermont Avenue, Los Angeles, CA, USA. mattingl@usc.edu.|Dale T. Mortensen Senior Research Fellow at the Institute of Advanced Studies, Aarhus University, Aarhus, Denmark. mattingl@usc.edu.|Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, 1033 Pine Ave, Montreal, QC, H3A 1A1, Canada. mattingl@usc.edu.
Cheryl
C
Mattingly
School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3600 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada. hiba.zafran@mcgill.ca.
Hiba
H
Zafran
Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, 1033 Pine Ave, Montreal, QC, H3A 1A1, Canada. laurence.kirmayer@mcgill.ca.
Laurence J
LJ
Kirmayer
D002170:Canada; D006801:Humans; D008603:Mental Health / Q000941:ethics*; D008605:Mental Health Services / Q000941:ethics / Q000458:organization & administration*; D009936:Organizational Innovation; D011050:Policy Making; D016730:Program Development; D036301:Qualitative Research; D012040:Regional Health Planning / Q000941:ethics / Q000379:methods / Q000458:organization & administration