From asylum to mental health: is the patient any better off?

The author offers a few reflections on the theme of the recent symposium of the Quebec Hospital Association: "De l'espoir à la Réalité" ("From Hope to Reality"). Twenty-five years after the report on quebec's psychiatric hospitals, what has become of the hopes and concerns of that time? Through all the changes that have occurred--from the hopes inherited from 1960 to the hopes articulated in the 1980s; from the "outmoded" realities of the institutional model to the realities considered "the way of the future", based on an ecological or bio-psycho-culturo-social model; from the preoccupations of the asylum to those of "mental health"--a fundamental question remains: Is the patient any better off? One might add a second question: WHich 'patient' are we referring to?