Facteurs contextuels influençant l’implantation d’un modèle de hiérarchisation des soins en santé mentale : une étude de cas en milieu montréalais
The purpose of the present study was to compare the care model of one Montreal local territory to the stepped-care model and to investigate factors influencing the implementation of this model. A qualitative case-study approach was employed involving 13 semi-structured interviews with services providers and managers from primary and specialist mental healthcare. Results showed that the hierarchical care model in place in this territory is compared in several points with the stepped-care model. However, some elements of these models have to be integrated to improve efficiency and quality of care, including the introduction of objective evaluation criteria and the specification of evidence-based interventions. Furthermore, some factors influenced the implementation of this hierarchical care model. Thus, the presence of collaborative working and learning strategies were identified to be a key condition. However, some elements must be considered to facilitate its success like the standardization of the referral criteria and process, the clarification of the mental health guichet d’accès (centralized access point) roles and the general practitioners' adherence to the care model. In conclusion, the use of the reference and analysis frames of this study may guide managers on issues to be considered to support the implementation of an evidence-based care model which may facilitate mental healthcare efficiency and its adequacy with the population needs.
Implementation analysis Mental healthcare (services) Service delivery and organization stepped-care model Mental health