Lettre d'appui des chercheurs internationaux en santé mentale

Subject: MENTAL HEALTH RESEARCHER’S STATEMENT ON CLOSURE OF THE 388

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February12, 2025

Dear Minister Lionel Carmant,

We, the undersigned professionals in mental health research, write to express our concern regarding the imminent closure of 'The 388' (Center for the Treatment of Young Psychotic Adults) in Quebec City. This decision, in our opinion, is a stark contradiction of trends and necessities emerging in mental health research worldwide. If scientific and therapeutic grounds for this decision exist, we urge the relevant authorities to disclose and substantiate them, so they may be subject to open discussion and scrutiny. Transparency in such decisions is essential to ensure they align with evidence-based practices and the broader goals of mental health care.

The field of psychosis research and treatment is inherently complex. A wide range of evidence accumulated in recent years suggests that the field is passing through, and must continue to pass through, a period of transformation at conceptual and practical levels. The limitations of predominant biomedical and pharmacological paradigms are increasingly evident to many researchers and clinicians working from a wide variety of perspectives. While these approaches remain valuable components of care, they alone are insufficient to address the range of challenges presented by psychosis, underscoring the need for complementary methodologies. Embracing diverse approaches fosters innovation by allowing new perspectives and practices to address longstanding challenges, particularly in a field as intricate as psychosis treatment.

It is in precisely these respects that the closure of The 388 strikes us as a very serious step in the wrong direction. We approach these issues from a variety of disciplinary backgrounds and perspectives. Yet we affirm the need to embrace diverse therapeutic models, including psychoanalytic and psychodynamically oriented talk therapy, in addressing the needs of individuals with psychosis. We likewise affirm the value of comprehensive, community-based treatment approaches. For such approaches to be truly embedded in their communities and responsive to the needs of their patients requires years of dedicated efforts from professionals. The 388 represents precisely such a deeply rooted, community-based model of care, which cannot simply be replaced by rerouting patients to other services.

This treatment is unique in the manner in which it integrates psychoanalysis and a singular modality of community-based care. By offering psychiatric and psychosocial follow-up, art workshops, and social activities, The 388 has created a model for holistic and individualized treatment that not only addresses clinical symptoms but prioritizes social and psychological reintegration of patients into their communities. Notably, it operates 24/7, providing immediate support during psychotic crises, preventing unnecessary and often harmful hospital admissions. In these respects, it not only aligns with but can continue to help shape best practices for the treatment of psychosis moving forward. It has a proven track record regarding the safety, satisfaction, and clinical outcomes of the populations it serves. External reviews of The 388 have been consistent in their praise for the quality of care and the high rates of success with a patient population whose prognosis is otherwise generally poor.

The closure of The 388 would dismantle a pioneering and well-established facility, erode the foundations of community-centered mental health care in Quebec, and represent a regression from the multifaceted approach modern mental health care demands. This would constitute a profound disservice not only to The 388’s patients and the local community but also to the global mental health community, which has much to learn from its innovative model of care. Such an institution is a rare and vital asset in the global pursuit of effective, innovative mental health care. Preserving such a center is not only a local imperative but a global opportunity to advance our collective understanding and treatment of psychosis.

We implore the authorities to reverse this decision and instead commit to the preservation and expansion of such facilities, which exemplify the progressive, pluralistic, and humane approach essential to the future of mental health care.

Respectfully,

‍Paulo Beer
Doctor
University of São Paulo

‍Philippe Bourgois
Professor of Psychiatry and Director of Center for Social Medicine
UCLA

The 388 clinic in Quebec has been a global model that has influenced psychiatrists and psychotherapists and psychoanalysts in the United States. It would be a shame for it to be closed.

Elan Cohen
Clinical Psychologist
Soho Psychoanalytic‍

The 388 is much more than a psychosis treatment center. Not only has the 388 produced the most impressive treatment outcomes in the global North, its practitioners have made invaluable contributions to philosophy, psychoanalysis, psychiatry, and many other fields concerning the human and human affairs. I have been a student of the 388 since 2016, hoping to learn as much as possible from their unique approach in order to proliferate their work. Closing this institution would be devastating for its patients, and for those who believe in the possibility of a better world.

Ellen Corin
Professor
McGill University‍

‍I strongly support the 388, a Center that offers high quality care for psychotic patients and that has amply demonstrated its efficacy. Its integrated, humane and psychoanalytically informed structure is unique and precious

John Dewitt
Professor and psychoanalyst
Université Aix Marseille

Maria Diban, Phd
Université Paris
Sorbonne du Nord

‍I support the 388 to continue it existence

Joanne Emmens
Psychotherapist/Lecturer
Essex University

Jasper Feyaerts
Professor of ClinicalPsychology
Ghent University

Caleb Gardner, MD
Harvard medical school: instructor

Emilia Halton-Hernande, MD
University of Essex

Laurie Kain Hart
Professor and Chair,
Anthropology, UCLA

Douglas Hollan
Distinguished Professor
Anthropology, UCLA

Derek Hook
Professor
Duquesne

The 388 is an essential institution whose work is revered by my PhD students - many of whom wish to have the opportunity to work there. It is the role model institution for innovative, humanistic, and truly devoted clinicians who have always been intent on understanding and treating psychosis in as sensitive and humane and respectfulway as possible. The administrators making the decision to close may not recognize the global reputation and significance of 388 - but it is an absolutely invaluable, one of a kind global leader in the field of psychoanalytic treatments ofpsychosis.

Kim Hopper
Professor of Sociomedical Sciences
Mailman School of Public Health, Columbia University

‍‍An original, incomparable project – a collective committed to humane crisis management and life- reclamation, a place of hope not resignation - that should be classified as a national treasure.

Derek Humphreys
MD, PhD, Full Professor
Directeur du Centre d'Études du Vivant
Université Paris Cité

Ippolytos Kalofonos
Associate Professor-in-residence
Semel Institute for Neuroscience & Human Behavior

Silvia Lippi
Psychoanalyst, Doctor in Psychology
Université de Nanterre

Tanya Luhrmann
Professor of Anthropology
Stanford University‍

Scientific research in psychosis suggests that the treatment of psychosis really requires psychosocial interventions, and that access to an array of such interventions improves outcome. The 388 appear to be serving a positive good for participants – and also reducing the economic costs of caring for the condition. Hospitalization is clearly the most expensive of treatments and it appears that participation in 388 strikingly reduces days of inpatient treatment. I urge you to keep 388 open.

Tracy McNulty
Professor
Cornell University

Reitske Meganck
Associate professor in Clinical psychology
Department of Psychoanalysis and Clinical Consulting,
Ghent University

Hakima Megherbi
Assistante professor of psychology
University of Sorbonne Paris Nord, France

Cezar Migliorin, Dr
Universidade Federal Fluminense

AlexanderMiller
Senior Research Officer
University of Essex

Ana Minozzo
Senior Research Officer
University of Essex

Neely Myers
Professor of Anthropology; Director of Health and Society Program
Southern Methodist University

Jordan Osserman, Dr
Department of Psychosocial and Psychoanalytic Studies,
University of Essex‍

As a mental health researcher and psychotherapist, it is deeply concerning to learn of the planned closure of this vital and world-renowned treatment centre. I urge those involved to reconsider this decision.

Michael Ryzner-Basiewicz, MA
Duquesne University

Nicolas Schwalbe
Doctor in Psychology (PhD)
Université Sorbonne Paris Nord

Kathryn Tabb
Professor
Bard College

Vaia Tsolas
Assistant Clinical Professor of Psychiatry
Albert Einstein, College of Medicine

Lizavetavan Munsteren
Postdoctoral researcher
University of Essex

Saiba Varma
Associate Professor of Anthropology
University of California San Diego

Camille Veit, PHD, MCU
Rennes 2

Marita Vyrgioti
Lecturer and Psychotherapist
University of Essex/ Tavistock and Portman NHS Trust