Implementation of the Quebec mental health reform (2005–2015)

Abstract

BackgroundThis study evaluates implementation of the Quebec Mental Health (MH) Reform (2005–2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined.MethodsEleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks.ResultsWhile implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH.ConclusionsSuccessful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1832-5) contains supplementary material, which is available to authorized users.

Variables associated with work performance in multidisciplinary mental health teams

“… 64 For example, members of new primary care teams who were transferred from specialized MH services where they had been long-standing staff members had to make significant adjustments in their working conditions. 64 For their part, specialized MH services were dealing with the aftermath of this considerable staff turnover while trying to avoid service duplication and maintain continuous care. 64 These findings agree with research suggesting that changing roles and identities negatively affect work performance.…”

“…This study took place as part of a larger evaluation 64 of a major MH reform in Quebec (Canada) health networks. 65 Canadian health services are mostly public and under provincial jurisdiction, but with financial support from the federal government.…”

“…Some professionals, such as psychiatrists and specialists in substance use disorders, were not included in primary care teams. 64 …”

Variables associated with interprofessional collaboration: a comparison between primary healthcare and specialized mental health teams

“…This study emanated from a larger evaluation of local health service networks (LHSNs) implemented under the 2005-2015 MH care reform [63,64] in Quebec (Canada).…”

Utilisation et enjeux des données clinico-administratives dans le domaine de la santé mentale et de la dépendance

“…Malgré les besoins élevés des personnes ayant des TM, incluant la dépendance, moins d'une personne sur deux (33 % à 46 %) rapporte utiliser les services pour raison de santé mentale (SM) sur une période de 12 mois [19][20][21][22][23][24] , et beaucoup rapportent des besoins non comblés [25][26][27] . Le dispositif de soins demeure toujours fragmenté, et l'accès ainsi que la continuité des services en SM sont à bonifier [28][29][30][31] . Le traitement des TM et de la dépendance nécessite des pratiques basées sur les données probantes 32,33 , et généralement un suivi coordonné de plusieurs dispensateurs de services, pouvant interagir à différents niveaux de soins : des soins primaires, spécialisés ou surspécialisés ; dans le domaine privé, public ou communautaire ; et dans le champ de la santé, du social ou de l'intersectoriel (p. ex.…”