title: Implementation of the Quebec mental health reform (2005-2015).
abstract: This 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.
  
  
  
  Eleven 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.
  
  
  
  While 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.
  
  
  
  Successful 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.
authors.affiliation: Department of Psychiatry, McGill University, 845 Sherbrooke Street, Montreal, H3A 0G4, Quebec, Canada. flemar@douglas.mcgill.ca.|Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada. flemar@douglas.mcgill.ca.
authors.forename: Marie-Josée
authors.identifier: 0000-0002-4743-8611
authors.initials: MJ
authors.lastname: Fleury
authors.affiliation: Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Grenier
authors.affiliation: Rehabilitation Department, Laval University, Quebec, Quebec, GIV 0A6, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vallée
authors.affiliation: Department of Social and Preventive Medicine, Laval University, National Public Health Institute of Québec, Quebec, Quebec, GIV 0A6, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Aubé
authors.affiliation: Department of Health Administration, Policy and Evaluation, School of Public Health, University of Montreal, Montreal, Quebec, H3T 3J7, Canada.
authors.forename: Lambert
authors.initials: L
authors.lastname: Farand
authors.affiliation: Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bamvita
authors.affiliation: Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Cyr
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D058006:General Practice / Q000458:organization & administration; D018166:Health Care Reform; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D011792:Quebec / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Collaborative care; Determinants; Implementation; Integration; Mental health reforms; Networks; Primary care; Shared-care; Strategies