Sex Offender Treatment Programming (SOTP) is a specific treatment intervention aimed at reducing recidivism through cognitive behavioral modification of known risk factors for sexual offending. SOTP provided in criminal justice or correctional settings and contexts presents unique ethical challenges and experiences for traditionally trained mental health counselors due to competing and differing roles, priorities, and stakeholders. SOTP in criminal justice or correctional settings is in some instances provided by professionally licensed or certified and traditionally trained mental health practitioners; and such settings can challenge traditional ethical standards and practices. A study was conducted utilizing qualitative phenomenology in order to investigate the ethical experiences of mental health practitioners providing SOTP in criminal justice settings. Semi-structured phone interviews were conducted with six professionally licensed or certified practitioners who were currently providing (or had recently provided) SOTP in criminal justice settings. Analysis of the data revealed thirty codes and six prevailing themes: unexpected entrance into the field of SOTP; ethical limits; role incongruence; competing obligations; imbalance between rehabilitation and community safety; and line of demarcation (“the line”). The essence of participant experiences was determined to be: who is the client? Meaning, participants identified ethical experiences that at their core indicated difficulty identifying to whom ethical obligations were owed. A model depicting the process of ethical experiences described by participants providing SOTP in criminal justice settings is offered. Future research questions and potential, related research projects are described. Implications for practice, counselor preparation, and research are summarized. The results of the present study may provide greater insight into a subject with limited research, while providing information for practitioners that may aid their ability to navigate complex ethical situations.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting up to 18% of all women, yet only 1.5% have been formally diagnosed. Untreated, PCOS is associated with the early onset of diabetes mellitus type II, heart disease, and cancer. One of the most common clinical symptoms of PCOS is mental health illness. The estimated lifetime prevalence of mental illness in women with PCOS is 80%. Therefore, mental health professionals may be especially poised to screen, refer, and address PCOS in their practices. This study was used to develop a survey tool as well as a brief educational intervention using framing theory to boost PCOS knowledge of diagnostic criteria and clinical symptoms, screening practices, and referrals for PCOS evaluation. The survey assessed mental health providers' knowledge about PCOS, estimates of PCOS prevalence in their practices, and evaluated attitudes about screening for PCOS in order to identify other potential barriers and facilitators to screening. This study was conducted using a randomized, two-group (experimental vs. attention control) design with three measurement periods: pre-intervention, 4-weeks, and 12-weeks. Participants were stratified by whether or not they had medical degrees. One-hundred and sixty three (N=163) participants completed the first survey and were randomized and completed one of the two educational interventions (PCOS related or attention control). Knowledge outcomes included number of correctly identified PCOS diagnostic criteria and clinical symptoms. Behavior outcomes included whether or not participants screened or referred clients for PCOS in the last 3 months. Fourteen attitude measures and two confidence measures were also separately evaluated as potential influencing factors of knowledge and behavior. The study resulted in no change in PCOS knowledge of diagnostic criteria or clinical symptoms or behavior based on intervention assignment in medical professionals; however, baseline knowledge in this group was high. Confidence in PCOS knowledge was associated with screening behavior. The PCOS educational intervention appears to have potential efficacy at increasing non-medical professional clinical symptom knowledge of PCOS (Chi-square(1)=5.341, p=0.021) but did not improve screening or referring behavior. The PCOS intervention resulted in greater confidence in PCOS knowledge in the PCOS intervention group than in the attention control group (p=.003). Framing theory appears to be a promising framework for messaging designed to increase knowledge about PCOS only in non-medical mental health practitioners. Results of this study should be interpreted with caution because sample size goals were not met and there was high attrition among medical mental health practitioners. Future intervention strategies should consider the inherent differences in the type of professional that are targeted (i.e. medical vs. non-medical) and the presence of specific barriers to screening and referral behavior. These strategies should improve upon the intensity of the intervention and the timing of the intervention to occur during provider training (i.e. during residency or early internships) in order to increase screening and referring behaviors for PCOS. / Public Health

L’objectif de ce mémoire est d’apporter des pistes de réflexion quant aux possibilités de prise en compte de croyances et spiritualités diversifiées en santé mentale. En reléguant la question des problèmes de santé mentale surtout aux psychiatres, entourés d’équipes de professionnels au nombre limité, comme les psychologues et les travailleurs sociaux, le système de santé québécois a créé certaines problématiques organisationnelles dans la structure même du soin. La situation s’est vue aggravée durant les dernières années : les problématiques en santé mentale sont en hausse, tandis que le système manque de personnel et d’endroits pour accueillir les patients. La stigmatisation de la maladie mentale est en partie causée par le manque de considération de l’expérience individuelle ainsi que le déni de la contextualisation du déséquilibre psychologique, c’est pourquoi il est impératif de considérer l’intégration d’approches novatrices et de champs disciplinaires variés pour répondre aux expériences individuelles et croyances uniques de tout un chacun. Cependant, le nouveau projet de loi (projet de loi 15) concernant la restructuration du système de santé ne prévoit pas déléguer le travail de psychiatres à d’autres types de professions. Les ressources alternatives proposent quant à elles une vision plus large de la maladie mentale et des thérapies non hiérarchiques adaptées à leurs usagers. Le mouvement alternatif a pris de l’expansion au Québec durant les années 80 et est toujours à l’avant-plan lorsqu’il est question de revendication des droits de la personne en matière de santé mentale. La spiritualité y est intégrée dans les services de façon transversale, via des activités à caractère énergétiques qui sont reconnues comme médecine douce, telles que la méditation pleine conscience et le yoga. La spiritualité dans les soins en santé mentale est reconnue par l’Organisation mondiale de la santé (OMS) depuis fort longtemps, et il importe de trouver un vocabulaire adéquat afin de communiquer l’importance d’une vie intérieure riche et d’entretenir l’espoir dans l’adversité. Certains psychiatres tel Jung, Perry, Grof et Grof, ont d’ailleurs développé des méthodes parapsychologiques pour accueillir les personnes qui éprouveraient des difficultés de nature psychique, telles que l’émergence et l’urgence spirituelle. Ces approches demeurent encore méconnues au Québec, mais elles ont néanmoins fait leurs preuves auprès de nombre de communautés à travers le monde. Le mémoire réfléchit à ces questions à partir d’une étude de terrain dans un organisme alternatif, et observe que l’intégration de la dimension spirituelle dans les soins de santé mentale demeure controversée à ce jour. Il dégage certaines pistes et recommande de former adéquatement les professionnels impliqués, afin qu’ils soient en mesure d’offrir des services adaptés aux différentes spiritualités de leurs patients. / The aim of this dissertation is to provide insights on the consideration of diverse beliefs and spirituality in mental health. By relegating the management of mental health problems mainly to psychiatrists, surrounded by teams of professionals, in limited in number, such as psychologists and social workers, the Quebec healthcare system has created certain organizational problems in the very structure of care. The situation has worsened in recent years: mental health problems are on the rise, while the system lacks personnel and places to accommodate patients. The stigmatization of mental illness caused in part by a lack of consideration for individual experience and a denial of the contextualization of psychological imbalance, which is why it is imperative to consider the integration of innovative approaches in varied disciplinary fields to address everyone’s unique individual experiences and beliefs. However, the new bill (Bill 15) regarding the restructuration of the healthcare system does not plan to delegate the work of psychiatrists to other types of professions. Alternative resources, on the other hand, offer a broader vision of mental illness and non-hierarchical therapies adapted to their users. The alternative movement expanded in Quebec in the 1980s and is still at the forefront of human rights advocacy in the field of mental health. Spirituality is integrated into services in a transversal way, through energetic activities that are recognized as alternative medicine, such as mindfulness meditation and yoga. Spirituality in mental health care has long been recognized by the World Health Organization (WHO), and it is important to find the right vocabulary to communicate the importance of a rich inner life and to sustain hope in the face of adversity. Some psychiatrists, such as Jung, Perry and Grof, have developed parapsychological methods for dealing with people experiencing psychic or spiritual difficulties, such as emergence and spiritual urgency. These approaches are still little-known in Quebec, but they have proven their worth in many communities around the world. The thesis reflects on these issues from a field study in an alternative organization and observes that the integration of the spiritual dimension into mental health care remains controversial to this day. It outlines certain avenues and recommends that the professionals involved be properly trained to offer services adapted to the different experiences and beliefs of their patients.