How mental health ministerial orientations generate change in public health system: Lessons from the Quebec experience with regard to new practices implementation

Current mental health problems, mainly depressive and anxious disorders, represent a challenge for public health: they are frequent and concern almost every age group, mainly young adults. But many people with those problems don’t use health services, and if so, these problems are often under diagnosed and under treated, with access and continuity pitfalls. Even if there is any treatment, it’s often partial or too brief. For many years, health system in Quebec has invested to enhance care and service answers to mental health problems, considering the major consequences on mentally sick persons, their relatives and society. In June 2005, a ministerial Action Plan in Mental Health was produced with orientations and measures to improve mental health care and services. Main aims were to upgrade service quality, to optimize existing resource utilization and to reinforce service coordination by fostering dialogue between main mental health actors. Ninety-five health and social services centres (CSSS), the actual basis of Quebec health system since 2004, must implement the recommended changes. To do so, they work with local service networks bringing together all sound partners. From 2006 to 2010, the Dialog research project is documenting numerous aspects related to the implementation of those changes for 15 CSSS and three remote regions mainly inhabited by native people. Those changes happen in diversified contexts characterized by specific historical highlights, in which health system complexity also implies coexistence of various logics and continual negotiations in an ever moving landscape. The presentation is based on the results of the project contextual section. They illustrate what’s happening and how we actually understand those changes, including description of the main factors shaping it, those observations going beyond Quebec own experience. They include change analysis, with a specific interest for collaborative processes.