Integrated services networks and their response to the needs of people with serious mental health problems

by Marie-Josee Fleury, Celine Mercier | Nov 01, 2004

Key Implications for Decision Makers

Integrated services networks are emerging as a logical solution for reforming the healthcare system. This study focuses on the methods of organizing integrated services networks for adults coping with serious mental health problems and on their effectiveness in adequately meeting the needs of these clients.

  • Adequate response to the needs of mental health clients requires the presence of a network that has sufficient resources and partners, which assumes a high level of integration and broad diversification of services. Better intake of clients in the community could be achieved by consolidating the mental health role of CLSCs, community organizations, intersectoral bodies, and family physicians and by optimizing integration of services.

  • Networks that best meet the needs of their users are those that have implemented the largest number of integration strategies, not only clinical but also structural and administrative, involving various integration targets (such as organizations, professionals, and clients) and regulatory levels (strategic, tactical, and operational).

  • Formalizing the integration and rationalization processes for organizations and the use of service paths is essential to consolidate the implementation of integrated services networks.

  • In parallel with issues of organizing services, the following implementation procedures help ensure the successful introduction of networks: significant involvement by the regional agency and the ministry; the presence of strong governance for regulating networks; the involvement of all partners; a shared vision of the objectives of reform and the organization of services; and clarification of missions and operating procedures.

Executive Summary

The research strives to better identify the methods for organizing integrated services networks and their capacity to meet the needs of adult clients coping with serious mental health problems. In the current context of transforming healthcare systems, integrated networks are presented as an organizational model that fosters enhanced quality of services. In particular, the research is designed to examine: 1) the capacity of models for organizing services into networks to respond to local conditions (urban, semi-urban, and rural), particularly to the needs of adults coping with serious mental health problems; 2) the needs of these adults; 3) sound practices for integrating services into networks; and 4) the key components of effective integration of services. Networks have been targeted in five socio-health regions, selected because they represent all the urban, semi-urban, and rural territories and because they are the sites of promising experiments to introduce networks. The study was based on interviews (n=165), observations by participants (n=14), and questionnaires (n=113 service providers and n=338 users and key workers). The research consists of a conceptual framework with three components: 1) an organizational analysis; 2) a needs analysis; and 3) an analysis of the adaptation of networks to these needs.

Findings and implications

  • Three models for organizing services into networks were defined, linked to the characteristics of territories, interorganizational dynamics, and the levels of integration deployed: 1) mixed; 2) centralized around the hospital; and 3) centralized around the CLSC. This last model is divided into two sub-models based on the presence or absence of a large pool of ultra-specialized resources. The networks that deploy the highest degree of integration generate the most interesting effects in terms of quality of services. They are most successful in meeting client needs. They also have adequate quantity and diversity of resources, and the distribution of power among organizations (hospitals, CLSCs, and community organizations) is more balanced. These networks correspond to the mixed and CLSC 1 models. The research findings therefore highlight the importance for implementing networks with 1) an optimal level of intra- and interorganizational integration; 2) deployment of adequate quantity and diversity of resources (essential range of services); and 3) dispersal of resources and responsibilities among partners in a network with a view to efficiency and diversification of services. The networks that have best met these conditions are most successful in meeting the needs of their clients.

  • The main unmet needs of clients coping with serious mental health problems, regardless of territory, are daily activities, social relations, and information about the disease and treatment. The research also identified the major shortcomings of the respective networks: difficulties accessing housing, adapted transportation, work integration, follow-up in the community, a family physician, and psychiatric consultation. These shortcomings especially affect people with multiple problems. Efforts therefore should be made specifically to close these gaps in the delivery of services, and clients with multiple problems should be specially targeted by the mental healthcare system to respond more effectively to the complexity of their problems.

  • The networks with the best performance have deployed more structural, administrative, or functional and clinical integration strategies. Clinical integration, although central, is insufficient if not supported by an adequate structural and functional arrangement. Integration must also be developed and alignment must be co-ordinated at various levels - strategic (senior executives), tactical (middle managers), and operational (workers) - and for various targets - system, client (or resources) programs, organizations, professionals, and clienteles. The relevance of formalizing integration processes is also demonstrated, especially in cases of substantial transformation of practices, rapprochement of organizations with different cultures, and related systems. Formalization restores the functional, relational, or structural spaces, promoting practice in integrated services networks and providing an incentive for developing a culture of partnership. It also ensures the sustainability of transformations. Networks therefore have every interest in increasing their integration strategies to formalize procedures for co-ordination and continuity of services. At this stage, the introduction of integrated services networks in mental health is still fairly uncommon and few common clinical tools have been developed.

  • Active involvement of the regional agency and the ministry is a key component of effective integration into networks, in part taking the form of adequate funding and establishment of a solid governance authority for networks. Other winning conditions include clarification of missions and recognition of the expertise of organizations, planning for the organization of services centred primarily on client needs, establishment of working committees on targeted problems involving collective leadership, and a sound knowledge of reform objectives and issues.

  • The introduction of integrated services networks therefore consists of considering the best models for organizing services based on an organizational logic (for example, models, strategies, sound practices), a population or client-based logic (for example, path for use of services, client perceptions of what constitutes sound integration practices), and procedures that promote or hinder the introduction of such networks.