Pierre Pariseau-Legault

Cet article s’intéresse à l’usage narratif du diagnostic, formel et informel, comme forme narrative qui dit la vérité sur soi. Nous débutons par un bref tour de la littérature portant sur les usages sociaux des diagnostics hors de l’univers médical. Vingt-cinq (n=25) entretiens semi-directifs ont été menés auprès d’individus aux profils variés et qui s’identifient sur un ou plusieurs des trois axes suivants : la neurodiversité, la diversité corporelle et la diversité sexuelle et pluralité des genres. Mobilisant une analyse de discours sollicitant la pensée foucaldienne du rapport à soi et des régimes de vérité, nous faisons état des six thématiques qui ont émergé: l’enquête personnelle tournée vers une forme préalable, la conceptualisation du diagnostic, son inscription dans une histoire humaine et familiale, sa compréhension par rapport à des singularités interactionnelles, sa reconnaissance phénoménologique et finalement, la présence de diagnostics hors diagnostic, soient des catégories qui fonctionnent comme des diagnostics mais qui n’en constituent pas. La recherche d’un diagnostic devient un acte de vérité, une technique de soi qui s’inscrit dans des rapports subjectivants. Les diagnostics pourraient bien aujourd’hui occuper ce rôle de dispositif narratif afin de se raconter et de mieux se comprendre.

Compassionate nursing practice frequently requires nurses to navigate competing obligations, conflicting patient needs and constrained resources. While compassion motivates responsiveness to suffering, it does not always provide sufficient guidance for determining how such conflicts should be resolved. We argue that contemporary forms of utilitarianism may offer a useful framework for structuring compassionate practice in nursing within ethically pluralistic clinical environments. Drawing on contemporary utilitarian thought, particularly preference utilitarianism, the paper examines how attentiveness to suffering, preservation of dignity and responsiveness to patient vulnerability may be reframed around ethical deliberation under competing demands. Through clinical examples, we explore how compassionate nursing practice often involves the weighing of competing preferences, the prioritisation of morally significant needs and the allocation of finite professional attention. We argue that preference utilitarianism can fruitfully provide a structured ethical resource for evaluating actions according to their capacity to reduce and prevent suffering while respecting individual preferences and circumstances. The paper does not propose a foundational moral theory for nursing. Rather, it argues that preference utilitarianism can function as a complementary ethical resource alongside care ethics, virtue‐based approaches and other relational perspectives, particularly in situations where nurses must navigate conflicting ethical duties. It therefore demonstrates how compassionate actions can be morally justified and systematically assessed, supporting a move from isolated acts of care towards more sustained and context‐sensitive ethical practices within healthcare systems.

Introduction: Psychiatric and mental health services have been increasingly scrutinized for sustaining coercive and epistemically unjust practices. Allyship, conceptualized as a commitment to power redistribution, has emerged as a strategy to address such injustices. Aim: The aim of this study is to map the literature and current state of knowledge regarding allyship in psychiatry and mental health. Method: A scoping review was carried out. Tirthy‐four ( n = 34) reports were subjected to a descriptive and thematic analysis. Results: The analysis of the literature identifies four interrelated and complementary themes characterizing allyship: (1) the scope of allyship in mental health, (2) its general principles, (3) the qualities expressed by allies and (4) their repertoire of actions. Discussion: Reviewed studies depict allies as reflexive agents aware of their privilege and advocating for patients. However, findings reveal ethical tensions between performative and effective allyship, with risks of reinforcing paternalistic structures rather than dismantling them. Implication for Practice: The results highlight the ethical responsibility of psychiatric and mental health professionals to resist mere symbolic or performative allyship. Recommendations: This synthesis underscores the ethical imperative to anchor allyship in principles of social justice, epistemic humility, and mutual emancipation. Relevance to Mental Health Nursing: Allyship has been the subject of significant debate in psychiatric nursing. The results of this review inform nursing practice by identifying the principles, qualities, and defining actions of individuals who seek to become and act as allies. The findings presented also outline avenues for action aimed at adapting educational curricula to incorporate key dimensions of allyship, including the recognition of privilege, the redistribution of power, and epistemic humility. Finally, this scoping review serves as a caution against the uncritical use of the ally concept, to avoid the erasure of its political foundations.

The past two decades have witnessed a great interest in psychometric research in nursing, characterised by a marked increase in measurement tools. This approach has been lauded for its methodological sophistication—yet beneath this polish lies an unexamined ethical cost. This paper interrogates the proliferation of psychometric instruments as an indicator of deeper disciplinary tensions: the quest for legitimacy, the valorisation of quantifiable research output and the bureaucratic allure of metrics. We examine three core risks—namely ethical redundancy, resource misallocation and evidence fragmentation—and argue for a recalibration of instrument development grounded in collective accountability, theoretical coherence and editorial restraint.

Introduction: Psychiatric nurses are actively involved in involuntary hospitalisations and treatments. However, the scientific literature lacks insights into strategies used to navigate roles and institutional expectations in this regard. Aim: To achieve a deeper understanding of practices that support the exercise of individual rights in psychiatry during involuntary hospitalisations and treatments. Method: A situational analysis was conducted. Nineteen ( n = 19) mental health workers participated in a semi‐structured interview and completed a socio‐demographic questionnaire. Case law review ( n = 126) and non‐participant observations ( n = 70 h) were also conducted. Results: The moral division of labour is a central element in mental health interventions, organising four types of practices: socio‐legal assistance, support for exercising rights, intersectoral coordination and ignorance and trivialisation. Discussion: Our findings reveal that nursing care is predominantly medicalised, confining nurses to a subordinate role. They also indicate marginal practices focused on socio‐legal assistance and human rights support. Intersectoral coordination, though crucial, remains an invisible aspect of nursing practice. Implications for Practice: There remains a significant lack of awareness about human rights issues in psychiatry. This research underscores the importance of considering professional hierarchies, organisational expectations and legal awareness to address role conflicts in psychiatric care. Relevance Statement: This research highlights the need to study nurses' agency, offering insights into how they interpret and apply psychiatric laws. Such research could deepen knowledge on human rights issues in psychiatry or, at minimum, promote greater recognition of these concerns. Social policy implications are also notable, underscoring the need for integrated socio‐legal assistance during involuntary treatments to support patients navigating complex systems and exercising their rights. Finally, the findings point to the importance of examining professional hierarchies, organisational expectations and legal awareness in developing practices that address the emotional, educational and intersectoral aspects of psychiatric coercion.

Background/Objectives: Perceived coercion has been associated with significant negative outcomes, including service avoidance and psychological distress. Despite growing interest, no recent comprehensive review has mapped the full range of factors influencing this experience. This scoping review aimed to synthesize and present the state of knowledge on the factors associated with perceived coercion by adults receiving psychiatric care. Methods: Following the Joanna Briggs Institute methodology, a systematic search of five databases and grey literature was conducted for publications from 1990 to 2025 in English and French. A total of 143 sources were included and thematically analyzed. Consultation with experts and individuals with lived experience enriched the interpretation of findings. Results: Five categories of factors were identified: individual, clinical, relational, legal, and structural. Relational and legal factors were most consistently associated with perceived coercion, while individual and clinical factors showed inconsistent findings. Structural influences were underexamined but significantly shaped the experiences of the individuals receiving care. Conclusions: Perceived coercion arises from a complex dynamic of individual, relational, and systemic influences. Reducing coercion requires moving beyond individual-level factors to address structural conditions and policy frameworks. Future research should prioritize qualitative and intersectional approaches and amplify the voices of those most affected by coercive practices in psychiatric care.

Access to mental health care remains a pressing global issue. In response, policymakers have devised strategies that span from self-care to psychotherapy, hoping to ease the strain. However, reforms over the past two decades have significantly restricted access to psychotherapy, limiting the number of professionals, such as nurses, allowed to practise under stringent conditions. This article examines the effects of Quebec’s public policies on the practice of psychotherapy and mental health interventions. A critical discourse analysis, grounded in Strauss’s theory of negotiated order, was conducted on 48 policy documents and public discourses. The findings reveal that mental health interventions have become disconnected from their therapeutic essence, reduced instead to technical tasks. This shift perpetuates a hierarchical professional landscape, subordinating these practices despite their reliance on the relational dynamics that define effective mental health care. For the nursing profession, the implications are profound. The profession’s contribution to providing timely access to community-based mental health services is being overlooked, stymied by outdated perceptions and policy restrictions.

A growing body of literature highlights the involvement of nurses in the application of involuntary commitment and treatments in psychiatry. The violence underlying these coercive practices is often discussed, as they infringe on human rights and have negative effects on both patients and healthcare staff. The current state of knowledge on this subject, however, fails to inform us of what characterizes and influences these practices in psychiatric nursing. A situational analysis was conducted to gain a better understanding of this issue. This qualitative research aims to explore the characteristics of nursing care during involuntary commitment and treatments. In all, 10 nurses ( n = 10) and 11 patients ( n = 11) participated in semi-structured interviews and completed a sociodemographic questionnaire. Data analysis followed a grounded theory approach, involving a process of coding, conceptualizing, categorizing, constant comparison, and relational mapping, accompanied by analytical memos. Four conceptual categories emerged from data analysis: (1) Psychiatry as a waiting room, (2) nurses as subordinates, (3) nothing else but medication, and (4) resisting undignifying care. The results suggest that clinical issues surrounding involuntary commitment and treatments can be explained by how care is conceived. The psychiatric nursing practice seems to be limited to the application of coercive power, such as forced administration of medication. The distress potentially induced by involuntary commitment and treatments in patients comes to be ignored in favor of compliance with the legal procedures. The results describe a situation where patients felt abandoned to those procedures as if refusing to be hospitalized or treated were incompatible with any other form of care. Several participants also report having suffered negative consequences following one or more coerced psychiatric episodes. For them, refusal of care therefore seems to be associated with a resistance against the current violence of biomedical psychiatry, rather than a refusal to obtain help and support.

Les accouchements non assistés (ANA) font référence au fait que certaines femmes choisissent de vivre un accouchement en l’absence de professionnel·les de la santé alors que des structures médicales sont normalement disponibles pour les soutenir si elles le désirent. Au Québec et ailleurs dans la francophonie, à notre connaissance, aucune recension des écrits n’a été publiée malgré les questionnements croissants concernant ce phénomène. Cet article vise ainsi à présenter les résultats d’une recension systématique des écrits (n=32) qui porte précisément sur les ANA. Nos résultats décrivent le profil sociodémographique des femmes qui choisissent les ANA, les motivations et le processus décisionnel lié à ce choix, les risques socioculturels auxquels ces femmes sont exposées et la place qu’occupent les réseaux socionumériques dans ce processus décisionnel. Afin d’élargir notre compréhension de ce phénomène, nos résultats sont ensuite mis en dialogue avec d’autres situations de non-recours aux services de santé et d’autres pratiques familiales alternatives.

The term ‘mental health crisis’ is a widely used concept in clinical practice and research, appearing prominently in mental health literature across healthcare and social science disciplines. Within these contexts, the term is frequently either left undefined or defined rather narrowly, confined to clinical observations or guidelines targeted at healthcare providers and negating the multifaceted nature of crisis as described by those with lived experience. Therefore, the aim of this paper is to explore the characteristics of and provide a conceptual definition for the concept of ‘mental health crisis’. Rodgers' method of evolutionary concept analysis was employed and 34 articles, ranging from 1994 to 2021 and a variety of disciplines, were analysed. The results highlighted the contrast between clinically oriented surrogate terms and related concepts and those used by individuals with lived crisis experience. Antecedents of crisis included underlying vulnerabilities, relational dysfunction, collapse of life structure and struggles with activities of daily living. The concept's attributes encompassed the temporality of crisis, signs and symptoms of crisis, functional decline and crisis in family and caregivers. Finally, the consequences comprised looking inward for help, looking outward for help, and opportunities and dangers. This concept analysis serves as a foundational step in understanding ‘mental health crisis’ and its various dimensions, facilitating more nuanced discussions and interventions in the realm of mental healthcare.