Academic journal article Health and Social Work

From the Real Frontline: The Unique Contributions of Mental Health Caregivers in Canadian Foster Homes

Academic journal article Health and Social Work

From the Real Frontline: The Unique Contributions of Mental Health Caregivers in Canadian Foster Homes

Article excerpt

Foster homes have existed in North America for the past 50 years, as many patients discharged from psychiatric hospitals were placed into these homes (Deci & Matrix, 1997; McCoin, 1985; Murphy, Penne, & Luchins, 1972; Trainor, Morrell-Bellai, Ballantyne, & Boydell, 1993). These community-based residences provide an important source of housing for people with mental health problems, many of whom have lived for years in institutional settings. Unlike most services for people with serious mental illness, which rely on professional staffing (that is, assertive community treatment), nonprofessional caregivers operate foster homes, which are indistinguishable from ordinary homes in the community.

Foster homes originated in Belgium where over 600 years ago families in Geel took people with mental illness into their homes (Carpenter, 1978; Linn, Klett, & Caffey, 1980; McCoin, 1983; Roosens, 1979). The concept of caring for someone in a natural family environment spread throughout Europe during the 1800s and was introduced in the United States in 1885 (Linn, 1981; Tuntiya, 2006). Although in recent years emphasis has shifted to more autonomous housing, such as supported housing, foster homes remain the oldest form of housing for people with serious mental illness (McCoin, 1985).

In Quebec, Canada, foster homes are also known as family-type residences, and are regulated by provincial jurisdiction (Bill 120, Law Respecting Health and Social Services; Government of Quebec). Canadian foster homes are analogous to the traditional adult foster home model in the United States, defined as three or more individuals in a residential care facility, small group home, or family-type setting under state regulation (Deci & Mattix, 1997). Yet adult foster care is only one alternative in a plethora of U.S. residential options for people with serious mental illness, including board and care homes (Morgan, Eckert, & Lyon, 1995); the Homeshare Program, where single clients are integrated into private homes (Rhoades & MacFarland, 1999); or supervised community residences (Getty, Perese, & Knab, 1998).Whereas Canadian foster homes are a public sector service, in the United States there is a trend toward the development of private, for-profit housing services under managed care (Byrne, 1999; Shera, 1996).

Although foster homes have flourished, in Canada they have not been viewed in a positive light. This poor image dates back to a study by Murphy et al. (1972) that criticized foster homes as places that merely provide room and board, are too structured and controlling, and do little to reintegrate people with serious mental illness into the community. Over time, foster care in Quebec has evolved from a "caretaking" to a "professional" model in which social workers play a key role. They supervise these homes, ensure quality service, and act as intermediaries between foster homes and the mental health system (Dorvil, Guttman, Ricard, & Villeneuve, 1997). Social workers are responsible for recruiting caregivers and for matching and placing clients in these homes. A social worker, serving as case manager, is assigned to each resident. According to Quebec Ministry of Health directives, an individual service plan for each resident must be developed collaboratively between a resident's social worker and caregiver.

Caregivers are nonprofessionals, mostly women, who house and care for up to nine residents, whom they are mandated to reintegrate into the community. They and their residents are initially strangers who contract to live together and, when successful, usually do so for many years (Douglas Hospital, 2006). The Quebec Ministry of Health stipulates that caregivers be paid a per diem for supporting people with serious mental illness in their homes. Caregiving offers advantages such as a flexible schedule, the possibility to be one's own boss, opportunities to learn, and the rewards of seeing good results with residents. …

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