Transforming Front-line Mental Health Care in Québec: Support and Follow-up

Louise Fournier
Principal Investigator, CRCHUM, Université de Montréal, INSPQ

Summary Report (PDF, 242 KB); Appendices (PDF, 2.2 MB, in French only)

Québec’s Mental Health Action Plan 2005-2010 (PASM) sets out major organizational changes throughout the province. However, the pace and scope of changes vary greatly by setting studied. The challenges met were virtually identical across the territories, but the particular characteristics of each territory shape the direction and extent of the changes.

Common issues were primarily the alignment between front- and second-line services, and, more generally, between medical and other professional services. The procedures set out in the PASM, in particular the tiering of care and the implementation of a single service window, are intended to create this alignment. However, local service networks were largely left to their own devices in how to establish them, and generally did not receive effective support from the Agences régionales de santé et des services sociaux. Building bridges with the community network seems to have been less problematic. All territories also had to deal with a shortage of professional resources, even where financial resources were available. 

Local networks that implemented PASM objectives relatively quickly were characterized by an established tradition of cooperation between actors, effective liaison, existing support from psychiatrists to front-line services, a medical presence with local authorities and a mix of professional practices (nurses or other professionals present in the clinics). 

The fact that the health and social service centres (CSSS) were created and the PASM deployed at the same time had a number of effects. It encouraged the adoption of a population-based approach and employee mobility; however, this mobility complicated the building of trust between partners. Likewise, where psychiatry departments were integrated to the structure of the CSSS, the transfer of second-line professionals to the front line made it more difficult for the lines of service to work more closely with one another.