The Mental Health Action Plan is transforming the mental health system in Quebec.
In 2005, the Québec Ministry of Health and Social Services adopted the Mental Health Action Plan (MHAP), which aims at offering better care and services and improved access for people suffering from mental illness. What is this reform exactly? How does it affect the Douglas and the patients treated there? This section will present the essence of this reform.
Context: an ever increasing demand in psychiatric hospitals
Mental health services and mental health workers in Montreal have until now been concentrated in hospitals specializing in psychiatry (such as the Douglas) and in general hospitals with a department of psychiatry.
Every year on the island of Montreal, approximately 142,000 people (7.6% of the population) use the mental health services offered through the health care system. Of this number, 60% consulted for disorders that do not generally require a hospital environment.
However, due to a lack of organization in mental health services offered in general points of service such as the CLSCs, psychiatric hospitals (which specialize in treating people suffering from serious mental health problems) find themselves obliged to respond to an ever-increasing demand, which results in corresponding delays in access to services.
Faced with this situation, and in order to respond more effectively to the needs of the population, the Québec Ministry of Health and Social Services decided to introduce major changes designed to improve the continuity of mental health services and provide better access to them.
Improve the access and continuity of mental health services
The reform main objective is to ensure that Quebec has an efficient mental health care system that offers access to treatment and support services for children, youth and adults of all ages (including those 65 and over) suffering from a mental health problem.
A new approach of mental health care and services in Quebec
People suffering from a mental health problem will have to access care and services via the "accueil psychosocial" of his/her CLSC or through 1st line general practitioners.
Patients who go to the "accueil psychosocial" of their CLSC will be evaluated by professionals who will be mandated to determine whether they need:
- to receive general 1st line services
- to be referred to the services of a team of 1st line mental health professionals in the CSSSs
- to be given rapid access to more specialized (2nd or 3rd line) services such as the Douglas Institute.
Patients who go to the 1st line general practitioner directly may, depending on the state of their mental health:
- be treated by the general practitioner;
- be referred to the CSSS via the «guichet d'accès»
- be treated by the team of 1st line mental health professionals in a CSSS
- be referred to more specialized (2nd or 3rd line) services.
Glossary: to better understand Quebec health network
Centre de santé et de services sociaux (CSSS)
A group of health care institutions that offer 1st line health and social services for the residents of a territory. Generally, the CSSS includes a general hospital, a CLSC and a Residential and Long-Term Care Centre (CHSLD). In Quebec, there are 95 CSSSs, including 12 on the island of Montreal. From its geographical location, the Douglas Institute works very closely with its partners, the CSSS Sud-Ouest-Verdun or the CSSS Dorval-Lachine-LaSalle, and often collaborates with other CSSSs.
1st line
Once the reform will be completed, the 1st line will treat 70 % of all mental health cases in the population. The 1st line is therefore the first level of access to services. These services promotes health, prevent disease and offer diagnostic, curative and rehabilitation services to the public. They are designed to respond to a variety of current health and social problems, which is why they must be offered close to the communities where the people actually live.
In mental health, 1st line services of are of two types: general services offered to the population as a whole and 1st line services designed specifically for mental health.
1st line services are offered by the CSSSs, private medical clinics, family medicine groups (FMGs), by psychologists working in schools or in private practice and by certain community organizations. The hospitals take charge of emergency cases. In the CSSSs, the mental health teams, in close collaboration with the professionals on their territory, particularly those in the FMGs, will be able to provide 1st line treatment to the majority of those evaluated at the "guichet d'accès".
2nd line
Once the reform is completed, the 2nd line will treat 29 % of all mental health cases in the population. With few exceptions, people who access these services are directed here by a 1st line services professional.
2nd line services require special expertise. They support 1st line teams by treating those that cannot be treated adequately by 1st line services. The range of 2nd line services includes:
- specialized evaluation and treatment;
- hospitalization
- treatment in a day hospital
- intensive follow-up in the community
- specialized support for children and youth.
3rd line
Once the reform is completed, the 3rd line will treat 1 % of all mental health cases in the population. These services are offered in a limited number of institutions, where health care services as well as research activities are taking place: university hospitals (CHU), university affiliated centres (CAU), psychiatric hospitals (CHPSY), and mental health university institutes, such as the Douglas Institute. They are accessible only to patients directed from another level of services and are intended for people who present very complex health problems, of low prevalence, or whose complexity requires a level of expertise not offered by 2nd line services.
Médecin spécialiste répondant en psychiatrie (MSRP)
The 'médecin spécialiste répondant en psychiatrie' (MSRP) acts as an expert resource for general practitioners and/or 1st line professionals who need a specialist. He gives opinions on psychiatric problems that require special expertise. Although he may, on occasion, intervene directly with a 2nd line client, the MSRP is not the psychiatrist for a specific population.
General practitioner
A physician who is specialized in general medicine.
Note: Several texts have been taken from the information kit produced by the Health and Social Service Agency of Montreal.
