Implementation of the MHAP 2005-2010: A work in progress

This past February, Quebec’s Ministry of Health and Social Services published an evaluation of the implementation of the province’s Mental Health Action Plan (MHAP) 2005-2010[1]. The report states that progress has been made in implementing many aspects of the MHAP and that noticeable improvements to service delivery and organization have occurred in regions where implementation efforts have been successful. However, the evaluation also revealed that full implementation of most local, regional and national measures remained incomplete both across and within regions, and that specified service targets have, with few exceptions, failed to be met.

A barrier mentioned repeatedly in the evaluation was that Health and Social Services Centres (CSSSs) and community organizations often lacked the financial and human resources needed to fully respect the MHAP’s targets. In a recent interview[2], the Minister of Health and Social Services, Dr. Réjean Hébert, echoed the need for more resources devoted to mental health. The Minister stated that he was extremely disappointed by the incomplete implementation of many of the MHAP’s strategies, failures he attributed primarily to the province’s inadequate investment in mental health programs.

But would such investments really have made a difference in the MHAP’s implementation? The answer is likely yes, but only to a certain point. Studies of organizational change identify the presence of sufficient resources as a key factor that facilitates change, but it is far from being the only factor that counts. The decentralized nature of service organization and decision-making in Quebec’s health system, as well as a lack of expertise and infrastructure to support mental health policy and practice implementation are two other factors that have had a major influence on the MHAP’s application.

It is also important to remember that there is a significant human element to large-scale system changes like the one initiated by the MHAP. In most reform processes it takes time for participants to develop partnerships, build trust and learn to operate in a functional way.  Indeed, this has arguably been the central success of the MHAP¾to mobilize a vast network of health system actors who now strive to achieve an increasingly clear and common vision.  Beyond new structures and service targets, unlocking the MHAP’s true strength will ultimately depend on the strategies used to nurture this evolving network, and to guide and support the relationships and collaborations that are so critical to transforming care and improving the mental health of the population.

[1] Ministère de la Santé et des Services sociaux (2013). Évaluation de l’implantation du Plan d’action en santé mentale 2005-2010 – La force des liens. Québec : Ministère de la Santé et des Services sociaux.

[2] Méthot, D. (2013). Santé mentale : le ministre Hébert très déçu des résultats du plan d’action 2005-2010. L’actualité médicale, numéro du 27 février.