Table 2.

Synthesis of the Mental Health (MH) Reform – implementation targets.

1-Quebec MH Reform: Targets achieved		PH-Group (n = 3)	WH-Group (n = 2)	SN-Group (n = 3)	LN-Group (n = 3)
MH one-stop service
MH one-stop service in all networks with a population of 50,000 inhabitants or more		3 (100%)	1 (50%)	1 (33%)	3 (100%)
Health and Social Service Centres (HSSC)-MH primary care teams (for adults)
20 multi-disciplinary MH clinicians/100,000		1 (33%)	1 (50%)	2 (67%)	1 (33%)
2 general practitioners (GPs)/100,000		0 (0%)	1 (50%)	0 (0%)	1 (33%)
Access to evaluation: 7 days		1 (33%)	1 (50%)	1 (33%)	2 (67%)
Access to treatment: 30 days		0 (0%)	1 (50%)	0 (0%)	2 (67%)
Intensive case management (ICM)
ICM in HSSC		1 (33.3%)	2 (100%)	2 (67%)	2 (67%)
ICM offered by MH community organizations (but under the responsibility of the HSSC)		3 (100%)	0 (0%)	0 (0%)	3 (100%)
Respondent-psychiatrists (shared-care model)
1 respondent-psychiatrist/50,000 (3 hours/service: to HSSC-MH Primary care teams and GPs)		3 (100%)	1 (50%)	3 (100%)	2 (67%)
Specialized MH services
Access to evaluation in specialized MH services: 14 days		0 (0%)	N.A.	0 (0%)	2 (67%)
Access to treatment in specialized MS services: 2 months		0 (0%)	N.A	0 (0%)	2 (67%)
Assertive community treatment programs (ACT)		1 (33%)	N.A	1 (33%)	1 (33%)
2- Main strategies to consolidate primary care or network integration, based on the literature [58]
2.1 Clinical Strategies
Evaluation/clinical tools: Establish clinical standardization and rationalization to promote best practices.[14]	Screening tools for MHDs Screening tools for SUDs Assessment tools for MHDs Assessment tools for SUDs Assessment tools for client satisfaction Clinical protocols or best practice guidelines	Mainly implemented in the PH Group
Clinical Approaches (Best practices)	Cognitive behaviour therapy (CBT): Psychotherapy aiming to change thinking and behaviour. Effective for most MHDs, including SUDs [59].		Mainly used in the WH-Group
	Motivational interviewing (MI): Brief intervention aiming to engage motivation to change behaviour. Mainly effective for SUDs [60].		Mainly used in the WH-Group
	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 in physical health for acute care, for which it has been proven effective, this care process aims at enhancing continuity of care and system efficiency. It is applied currently in MH [61].		Mainly used in the LN-Group
	Recovery approach: Personal journey that involves developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. In most longitudinal studies, recovery rates were 80% for bipolar disorders, 65% to 80% for major depression, 70% for SUDs and 60% for schizophrenia [62,63].		Mainly used in the SN-Group
	Strengths model: Intervention focusing on the strengths and interests of the user rather than pathology and oriented toward achieving goals set by the user him/herself. Mainly effective for severe MHD [64].		Mainly used in the SN-Group
	Illness self-management: Systematic provision of education and supportive interventions in order to increase skills and confidence of the client in managing his/her health problems. Mainly effective for depression [65].		Mainly used in the WH-Group
	Stepped-care: Care delivery model in which interventions are performed hierarchically based on the intensity of client problems. Mainly effective for depression [66].		Little used, but more in the PH-Group
2.2- Administrative Strategies
Referral mechanisms: Network resource directories Referral procedure within organization Referral procedure between organizations Shared clinical records			Mainly implemented in the PH- and WH-Groups
Shared staff: Professionals offering services across more than one organization to insure coverage of the required range of services and to intensify inter-organizational collaboration [14].			Little implemented, but more in the PH-Group
SUD specialist respondents: Specialists in SUDs who hold case discussions with MH and other teams concerning SUDs, aiming to reinforce SUD expertise and interventions including SUDs and co-occurring MHD-SUDs.			Mainly implemented in the WH-LN-Groups
Liaison officers: Professionals designated by an organization to relay information between departments of a single organization or between organizations serving the same clientele. [14].			Mainly implemented in the PH- and SN-Groups
Joint 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 [53].			Mainly implemented in the PH-Group
Service agreements: Administrative strategy used for formalizing mechanisms to facilitate access and continuity of services between at least two organizations or programs in the same organization [14].			Mainly implemented in the LN-Group