Thème : Quality primary care

Quebec’s Mental Health Action (MHAP) 2005-2010 proposes a reorganization of mental health services based on hierarchized care. This hierarchization consists of defining the care provided and the clients served by different service providers, as well as the interface management mechanisms between levels of care. Its objective is to improve the efficiency of the care system through better complementarity between service providers and by ensuring an increased continuity of care between them.

Mental health services are increasingly recognizing the key roles that primary care play in delivering mental health care in almost every community in Canada, and the importance of building collaborative partnerships to optimise these roles. Achieving this enables services to use their respective resources more efficiently, improve access to needed mental health and addiction services, better coordinate care, and improve the experience for the person seeking or receiving care for a mental health and addiction problem.

Supported Self-Management (SSM) for mood problems is a form of intervention in which: distressed individuals are provided with workbooks or websites designed to teach behavioural skills for mood self-management; and a healthcare provider or other supporter acts as a coach to help learn and apply the self-management skills. This intervention has shown an impressive degree of effectiveness for common mental health problems of mild to moderate severity.

People with mental health problems come to us seeking care on a daily basis. Complex issues and overcoming challenges are inevitable, therefore it is unrealistic to take on the task alone. Facing these issues effectively involves taking into account countless biopsychosocial factors and mastering very diverse specialized skills in interpersonal, diagnostic, therapeutic, social and community fields. Many clinicians have experienced the effectiveness of collaborating with various partners within their local network. In the context of a special report reviewing the literature on the effectiveness of collaborative mental health care in the treatment of depression, we will examine its daily clinical advantages experienced by both the population and clinicians.

Because of their high recurrence, experts now consider depressive and anxiety disorders to be chronic illnesses. Supported self-management (SSM) is an essential component in the Chronic Care Model, a standard to strive for when providing care for people with chronic illnesses, both physical and mental. Most clinical practice guidelines also recommend SSM for treating depressive and anxiety disorders (NICE, CANMAT).

The stepped care model seems to be a promising approach for improving quality of care for people with common mental disorders. To recap, stepped care is a health care model where interventions are prioritized according to patient needs. When the patient’s health does not improve following the interventions offered, progression towards more complex care is considered. This model would improve the current organization of mental health services.

Supported Self-Management (SSM) is gaining increasing recognition as an essential component in the treatment of people suffering from anxiety and depressive disorders. Most practice guidelines (NICE, CANMAT) recommend it. Finally, it is also part of the Chronic Care Model, which is progressively more popular for both physical illnesses and mental disorders.