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Table 1 Analytical framework and synthesis of the MH Reform implementation targets

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

Objective 1: Consolidation of the Health and Social Services Centers (HSSC) and Mental health (MH) primary care teams (HSSC-MH primary care teams) for the 11 local service networks under study
Quebec MH Reform targets Not achieved Partially achieved Achieved N/A
HSSC-MH adult primary care teams
 20 multidisciplinary MH clinicians/100 000 inhabitants 6   5  
 2 general practitioners (GPs)/100 000 inhabitants   * For a given network, achieved in some, but not all teams 9 1* 1  
 Access to treatment: 30 days 7   3 1
MH one-stop services
 A MH one-stop service in all networks with a population of 50 000 + inhabitants   * In one network, staffing incomplete   1* 9 1
 Access to evaluation: 7 days 5   5 1
Objective 2: Strategies used to consolidate primary care and improve quality of care
a) Consolidation of the respondent-psychiatrist function in the 11 networks under study
 Quebec MH Reform targets Not achieved Partially achieved Achieved N/A
 1 respondent-psychiatrist/50 000 (3 h/service per months: to HSSC-MH teams and GPs) 3   8  
b) Intensive case management
 Intensive case management in HSSC   * Required number of teams not achieved in 4 networks   4* 7  
 Intensive case management offered by MH community organizations (but under the responsibility of the HSSC) 6   5  
c) Clinical approaches & clinical evaluation tools based on the literature [67]
 Clinical approaches (Best practices) 7 approaches Stepped-care: Care delivery model in which interventions are performed hierarchically based on the intensity of client problems. Mainly effective for depression [25]. From high to moderate use (See Table 4)
Cognitive behavioral therapy: Psychotherapy aiming to change thinking and behavior. Effective for most mental health disorders, including SUD [26].
Motivational interviewing: Brief intervention aiming to engage motivation to change behavior. Mainly effective for substance use disorders [27].
Strengths model: Intervention focusing on the strength and interests of the user rather than pathology, and oriented toward achieving goals set by the user him/herself. Mainly effective for severe mental health disorders [28, 68].
Care pathways: Systematic interventions planned for integrating care between different organizational units or between providers for a well-defined group of clients and treatment periods. Originally established for acute medical care, for which it has been proven effective. This care process aims at enhancing continuity of care and system efficiency, and is also applied currently in MH [29].
Self-management: Systematic provision of education and supportive interventions in order to increase skills and confidence of clients in managing their health problems. Mainly effective for depression [30].
Recovery approach: Personal journey that involves developing a secure sense of self, supportive relationships, empowerment, social inclusion, coping skills, and new meaning in life. In most longitudinal studies, recovery rates were 80 % for bipolar disorders, 65 to 80 % for major depression, 70 % for substance disorders and 60 % for schizophrenia [31, 69].
 Clinical evaluation tools: establish clinical standardization and rationalization to promote best practices [14]. • Screening tools for MHD From high to low use (See Table 4)
• Screening tools for SUDs
• Assessment tools for MHD
• Assessment tools for SUDs
• Assessment tools for client satisfaction
• Clinical protocols and best practice guidelines
Objective 3- Strategies used to increase network integration (coordination between primary care and MH specialized services in each network)
 Integration strategies   10 key strategies Liaison officer: Professional designated by an organization to relay information between departments of the same organization, or between organizations serving the same clientele [14]. From many to few implemented (See Table 4)
Shared training: A strategy to enhance collaborative environments by simultaneously training clinicians with different areas of expertise, and/or from different services or organizations in a network [70].
Shared staff: Professionals offering services across more than one organization to insure coverage of the required range of services and to intensify inter-organizational collaborations [14].
Service agreement: Administrative strategy used in formalizing mechanisms that facilitate access and continuity of services between at least two organizations, or between programs in the same organization [14].
Referral mechanisms: • Shared clinical records • Network resources directory • Referral procedures within organizations • Referral procedures between organizations
SUD specialist respondent: Specialist in SUD who holds case discussions with MH and other teams concerning SUD, aiming to reinforce SUD expertise and interventions for both SUD and co-occurring MHD-SUD.
Individualized service plans: Mutual agreements among service providers, the client or his/her representative (or family) defining which care or service objectives to pursue. Plans usually target clients with multiple and often severe needs, who require case coordination involving several providers [71]. Not included in Table 4