The Health and Welfare Commissioner’s 4th report: Lessons learned?

The mission of the Health and Welfare Commissioner is to contribute to improving the health and welfare of the Quebec population through appraisals of the performance achieved by the province’s health and social services system. The Commissioner also makes public information that informs societal debates and government decision-making. In December 2012, the Commissioner released its fourth appraisal report, which examines the performance of Quebec’s mental health system.

The Commissioner’s report identifies five major action areas where steps should be taken to enhance system performance: reducing stigma in society, promoting mental health and preventing mental disorders especially in youth, strengthening primary mental health care, increasing access to psychotherapy, and enhancing government leadership in mental health while establishing a culture of continuous improvement. The report and its recommendations come at a critical time, as reflections have already begun on action areas to address in a new provincial action plan for mental health. In what ways might the Commissioner’s report enlighten these reflections?

In the past year, the government has already announced that the new action plan will include several priority objectives, notably to continue to bolster primary mental health care services, break silos and improve linkages and coordination between providers, increase early detection of mental disorders, and invest in the prevention and care of mental health problems in children and youth. The Commissioner’s recommendations completely support these strategic directions.  However, regarding the government’s efforts to reduce stigma, the report emphasizes the need to refocus attention and resources toward professionals within the health system as opposed to initiatives directed at the general public. The report also underscored the critical importance of making non-pharmacologic treatments more accessible across the province, a task that—if it is to be achieved—will require much deliberation, resolve and leadership on the part of the government and its partners.

Perhaps the most important lesson from the report is that all good policies are less beneficial when they are not adequately implemented. Despite the excellent intentions of the 2005 mental health action plan, a recurring theme in the Commissioner’s report was the incomplete implementation of many of its key initiatives: the guichet d’accès, primary mental health care teams, responding professionals, liaison agents, assertive community treatment teams, etc. Clearly, effecting large-scale system transformation is a complex process and determining how to achieve change is as important as deciding what to change. Developing a comprehensive strategy to support implementation and monitor progress of the new action plan would be wise and would increase the likelihood that we can all benefit from an effective, efficient and equitable mental health system.