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Source
Sante Ment Que. 2009;34(1):19-34
Publication Type
Article
Date
2009

Mental health service utilization among patients with severe mental disorders.

https://arctichealth.org/en/permalink/ahliterature143402
Source
Community Ment Health J. 2011 Aug;47(4):365-77
Publication Type
Article
Date
Aug-2011
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Jean Caron
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Canada. flemar@douglas.mcgill.ca
Source
Community Ment Health J. 2011 Aug;47(4):365-77
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Community Mental Health Services - utilization
Cross-Sectional Studies
Female
Health Behavior
Health Services Accessibility
Health services needs and demand
Humans
Male
Mental Disorders - diagnosis - psychology - therapy
Models, organizational
Patient Acceptance of Health Care
Primary Health Care - organization & administration - utilization
Quebec
Severity of Illness Index
Socioeconomic Factors
Abstract
In light of healthcare reforms, the study aims to assess variables associated with mental healthcare service utilization in general and in both primary and specialized care by patients with severe mental disorders (SMD, mainly schizophrenia). The study is based on a sample of 140 patients with SMD from five regions in Quebec (Canada). Variables were organized in accordance with Andersen's conceptual model into four factors: predisposing, enabling, needs, and service utilization. Secondary analyses were also conducted comparing patients who were hospitalized or used emergency rooms (H.ER-Group) with patients who did not use such services (WH.ER-Group). Accessibility of services, continuity of care, and having a case manager appear to be core variables that enable service utilization. Compared with the WH.ER-Group, the H.ER-Group used twice as many services. The study highlights the importance of developing a gamut of coordinated services, easily accessible in local networks, including case managers, family physicians, and shared-care development.
PubMed ID
20490675 View in PubMed
Less detail

GP group profiles and involvement in mental health care.

https://arctichealth.org/en/permalink/ahliterature139005
Source
J Eval Clin Pract. 2012 Apr;18(2):396-403
Publication Type
Article
Date
Apr-2012
Author
Marie-Josée Fleury
Jean-Marie Bamvita
Lambert Farand
Denise Aubé
Louise Fournier
Alain Lesage
Author Affiliation
Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre (DMHUIRC), Montréal, Québec, Canada. flemar@douglas.mcgill.ca
Source
J Eval Clin Pract. 2012 Apr;18(2):396-403
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bayes Theorem
Cluster analysis
Cross-Sectional Studies
Disease Management
Female
Humans
Male
Mental Disorders - therapy
Mental Health Services - organization & administration
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician's Role
Physicians, Family
Quebec
Questionnaires
Abstract
Mental health is one of the leading causes of morbidity worldwide. Its impact in terms of cost and loss of productivity is considerable. Improving the efficiency of mental health care system has thus been a high priority for decision makers. In the context of current reforms that privilege the reinforcement of primary mental health care and integration of services, this article brings new lights on the role of general practitioners (GPs) in managing mental health, and shared-care initiatives developed to deal with more complex cases. The study presents a typology of GPs providing mental health care, by identifying clusters of GP profiles associated with the management of patients with common or serious mental disorders (CMD or SMD).
GPs in Quebec (n = 398) were surveyed on their practice, and socio-demographic data were collected.
Cluster analysis generated five GP profiles, including three that were closely tied to mental health care (labelled, respectively: group practice GPs, traditional pro-active GPs and collaborative-minded GPs), and two not very implicated in mental health (named: diversified and low-implicated GPs, and money-making GPs).
The study confirmed the central role played by GPs in the treatment of patients with CMD and their relative lack of involvement in the care of patients with SMD. Study results support current efforts to strengthen collaboration among primary care providers and mental health specialists, reinforce GP training, and favour multi-modal clinical and collaborative strategies in mental health care.
PubMed ID
21114798 View in PubMed
Less detail

Management of mental health problems by general practitioners in Quebec.

https://arctichealth.org/en/permalink/ahliterature118080
Source
Can Fam Physician. 2012 Dec;58(12):e732-8, e725-31
Publication Type
Article
Date
Dec-2012
Author
Marie-Josée Fleury
Lambert Farand
Denise Aubé
Armelle Imboua
Author Affiliation
Department of Psychiatry, McGill University in Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Can Fam Physician. 2012 Dec;58(12):e732-8, e725-31
Date
Dec-2012
Language
English
French
Publication Type
Article
Keywords
Adult
Aged
Clinical Competence
Female
General Practice - organization & administration - statistics & numerical data
Health Care Surveys
Humans
Interprofessional Relations
Interviews as Topic
Male
Mental Disorders - diagnosis - epidemiology - therapy
Mental Health Services - organization & administration - statistics & numerical data - utilization
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - organization & administration - statistics & numerical data - utilization
Qualitative Research
Quality Improvement
Quebec - epidemiology
Questionnaires
Referral and Consultation - statistics & numerical data
Abstract
To document the management of mental health problems (MHPs) by general practitioners.
A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Régie de l'assurance maladie du Québec administrative data on medical procedures.
Quebec.
Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews.
The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system.
The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies).
The key role played by general practitioners and their support of the management of MHPs were evident, especially for CMHPs. For more optimal management of primary mental health care, multicomponent strategies, such as shared care, should be used more often.
Notes
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PubMed ID
23242904 View in PubMed
Less detail

[Mental health community organizations in Québec: role and partnership models].

https://arctichealth.org/en/permalink/ahliterature150728
Source
Sante Ment Que. 2009;34(1):101-26
Publication Type
Article
Date
2009
Author
Guy Grenier
Marie-Josée Fleury
Author Affiliation
Centre de recherche de l'Hôpital Douglas, Montréal.
Source
Sante Ment Que. 2009;34(1):101-26
Date
2009
Language
French
Publication Type
Article
Keywords
Budgets
Community Mental Health Services - classification - economics - organization & administration
Financial Management - organization & administration
Humans
Patient Participation
Quebec
Abstract
This study presents a global picture of the 371 government funded community-based mental health organizations (OCSM) and provides a description of the partnerships developed with community, institutional and inter-sector networks. The authors examine the diversity of the mental health community organizations based on the following characteristics: date of foundation, type and extent of territory, type and number of services offered, financial statement; participation in associations, participation in steering committees and models of partnership. The surface area of the territory, the size of the budget as well as involvement in steering committees appear to be enabling factors favouring the development of relations between organizations.
PubMed ID
19475196 View in PubMed
Less detail

Integrated local networks as a model for organizing mental health services.

https://arctichealth.org/en/permalink/ahliterature186923
Source
Adm Policy Ment Health. 2002 Sep;30(1):55-73
Publication Type
Article
Date
Sep-2002
Author
Marie-Josée Fleury
Céline Mercier
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Adm Policy Ment Health. 2002 Sep;30(1):55-73
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - organization & administration
Community Networks - organization & administration
Delivery of Health Care, Integrated - organization & administration
Health Plan Implementation
Humans
Models, organizational
Organizational Innovation
Quebec
Abstract
Organizing services in an integrated network as a model for transforming healthcare systems is often presented as a potential remedy for service fragmentation that should enhance system efficiency. In the mental health sector, integration is also part of a diversified response to the multiple needs of the clients, particularly people with serious mental health disorders. The authors describe how the notion of integrated service networks came to serve as a model for transforming the mental health system in Quebec, and they propose a frame of reference for this notion. They also address the challenges and issues raised by this mode of service organization in the mental health sector and more generally in a context of transforming healthcare systems.
PubMed ID
12546256 View in PubMed
Less detail

[General practitioners: practices and integration of mental health care in Québec].

https://arctichealth.org/en/permalink/ahliterature150729
Source
Sante Ment Que. 2009;34(1):55-76
Publication Type
Article
Date
2009
Author
Armelle Imboua
Marie-Josée Fleury
Author Affiliation
Centre de recherche de l'Hôpital Douglas, Montréal.
Source
Sante Ment Que. 2009;34(1):55-76
Date
2009
Language
French
Publication Type
Article
Keywords
Adult
Aged
Family Practice - organization & administration
Female
Health Services Accessibility
Humans
Male
Mental Disorders - therapy
Mental Health Services - organization & administration
Middle Aged
Physicians, Family
Quebec
Questionnaires
Abstract
This article examines the socio-demographic profile of general practitioners (GPs), their role in the management of (transient/moderate, severe/chronic) mental health disorders in different areas (urban, semi-urban, and rural) of Quebec as well as if their clinical practice and collaboration are oriented towards integration of mental health services. This crosswise study is based on 398 GPs representative of all Quebec GPs who answered a questionnaire. The study shows that GPs play a central role in mental health. According to territories, they have different socio-demographic and practice profiles. The types of territory and the degree of severity of mental health illnesses influence the propensity of GPs to integrate mental health care. Finally, GPs practiced mostly in silo, but they support greater integration of mental health services. The authors conclude that to improve mental health services integration, more proactive incentives should be favoured by political elites, adapted to the severity of the case and environments (urban, semi-urban or rural). However, the shortage of resources that is particularly striking in rural areas as well as inadequate mechanisms for clinical decision, reduce inter-relations and seriously limit the integration of healthcare.
PubMed ID
19475194 View in PubMed
Less detail

Determinants associated with the utilization of primary and specialized mental health services.

https://arctichealth.org/en/permalink/ahliterature134251
Source
Psychiatr Q. 2012 Mar;83(1):41-51
Publication Type
Article
Date
Mar-2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Jean Caron
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada. flemar@douglas.mcgill.ca
Source
Psychiatr Q. 2012 Mar;83(1):41-51
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Female
Health Care Surveys
Health Services Needs and Demand - statistics & numerical data
Humans
Logistic Models
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - utilization
Middle Aged
Models, Psychological
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - utilization
Quality of Life
Residence Characteristics
Risk factors
Social Support
Socioeconomic Factors
Young Adult
Abstract
The study aims to compare variables associated with the exclusive and joint use of primary and specialized care for mental health reasons by individuals diagnosed with a mental disorder in a Montreal/Canadian catchment area. Data were collected from a random sample (2,443 individuals). Among 406 people, diagnosed with a mental disorder 12 months pre-interview, 212 (52%) reported having used healthcare services. Compared to users of primary care only, people who sought both primary and specialized care presented more mental disorders and lower quality of life. People using only specialized healthcare received significantly less social support than persons using primary care exclusively and lived in neighborhoods with a high proportion of rental housing. Healthcare service provision should favor social networking and enable social cohesion and integration, particularly in neighborhoods with a high proportion of rental housing. Shared care and enhanced collaboration with other public and community-based resources should be encouraged.
PubMed ID
21607642 View in PubMed
Less detail

Comprehensive determinants of health service utilisation for mental health reasons in a Canadian catchment area.

https://arctichealth.org/en/permalink/ahliterature125584
Source
Int J Equity Health. 2012;11:20
Publication Type
Article
Date
2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Yan Kestens
Jean Caron
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal, Quebec H4H 1R3, Canada. flemar@douglas.mcgill.ca
Source
Int J Equity Health. 2012;11:20
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Community Mental Health Services - utilization
Crime Victims - psychology
Female
Humans
Male
Mental Disorders - diagnosis - epidemiology - therapy
Middle Aged
Patient Acceptance of Health Care - psychology
Regression Analysis
Residence Characteristics - statistics & numerical data
Sex Distribution
Social Class
Violence - psychology - statistics & numerical data
Abstract
This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area.
To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out.
Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females.
Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.
Notes
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PubMed ID
22469459 View in PubMed
Less detail

Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

https://arctichealth.org/en/permalink/ahliterature167409
Source
Can J Psychiatry. 2006 Apr;51(5):281-6
Publication Type
Article
Date
Apr-2006
Author
Marie-Josée Fleury
Guy Grenier
Alain Lesage
Author Affiliation
Department of Psychiatry, McGill University, Montreal, Quebec. flemar@douglas.mcgill.ca
Source
Can J Psychiatry. 2006 Apr;51(5):281-6
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Female
Humans
Male
Mental Disorders - epidemiology - therapy
Mental Health Services - standards - utilization
Needs Assessment
Professional-Patient Relations
Quebec - epidemiology
Rural Population - statistics & numerical data
Urban Population - statistics & numerical data
Abstract
This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas.
We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared.
The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs.
The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.
PubMed ID
16986817 View in PubMed
Less detail

Prevalence of psychological distress and mental disorders, and use of mental health services in the epidemiological catchment area of Montreal South-West.

https://arctichealth.org/en/permalink/ahliterature119350
Source
BMC Psychiatry. 2012;12:183
Publication Type
Article
Date
2012
Author
Jean Caron
Marie-Josée Fleury
Michel Perreault
Anne Crocker
Jacques Tremblay
Michel Tousignant
Yan Kestens
Margaret Cargo
Mark Daniel
Author Affiliation
Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Center, Montreal, Québec, Canada. jean.caron@mcgill.ca
Source
BMC Psychiatry. 2012;12:183
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Catchment Area (Health) - statistics & numerical data
Female
Health Services Needs and Demand - statistics & numerical data
Humans
Incidence
Longitudinal Studies
Male
Mental Disorders - epidemiology
Mental Health Services - utilization
Middle Aged
Prevalence
Quality of Life
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Risk factors
Risk-Taking
Self-Injurious Behavior - epidemiology
Stress, Psychological - epidemiology
Abstract
This report presents the initial results of the first Epidemiological Catchment Area Study in mental health in Canada. Five neighbourhoods in the South-West sector of Montreal, with a population of 258,000, were under study. The objectives of the research program were: 1) to assess the prevalence and incidence of psychological distress, mental disorders, substance abuse, parasuicide, risky behaviour and quality of life; 2) to examine the links and interactions between individual determinants, neighbourhood ecology and mental health in each neighbourhood; 3) to identify the conditions facilitating the integration of individuals with mental health problems; 4) to analyse the impact of the social, economic and physical aspects of the neighbourhoods using a geographic information system. 5) to verify the adequacy of mental health services.
A longitudinal study in the form of a community survey was used, complemented by focused qualitative sub-studies. The longitudinal study included a randomly selected sample of 2,433 individuals between the ages of 15 and 65 in the first wave of data collection, and three other waves are projected. An overview of the methods is presented.
The prevalence of psychological distress, mental disorders and use of mental health services and their correlates are described for the first wave of data collection.
Several vulnerable groups and risk factors related to socio-demographic variables have been identified such as: gender, age, marital status, income, immigration and language. These results can be used to improve treatment services, prevention of mental disorders, and mental health promotion.
Notes
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PubMed ID
23110632 View in PubMed
Less detail

[Can mental health problems be diagnosed by general physicians? Perspectives of family physicians according to administrative standards].

https://arctichealth.org/en/permalink/ahliterature150725
Source
Sante Ment Que. 2009;34(1):161-72
Publication Type
Article
Date
2009
Author
Youcef Ouadahi
Alain Lesage
Jean Rodrigue
Marie-Josée Fleury
Author Affiliation
MBA, Agent de planification, programmation et recherche, Agence de la santé et des services sociaux de la Montérégie.
Source
Sante Ment Que. 2009;34(1):161-72
Date
2009
Language
French
Publication Type
Article
Keywords
Chronic Disease
Humans
Mental Disorders - diagnosis
Physicians, Family
Quebec
Societies, Medical
PubMed ID
19475199 View in PubMed
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Determinants of the utilization of diversified types of professionals for mental health reasons in a Montreal (Canadian) catchment area.

https://arctichealth.org/en/permalink/ahliterature120697
Source
Glob J Health Sci. 2012 May;4(3):13-29
Publication Type
Article
Date
May-2012
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Jean Caron
Author Affiliation
Douglas Hospital Research Centre, Montreal, Quebec, Canada. flemar@douglas.mcgill.ca
Source
Glob J Health Sci. 2012 May;4(3):13-29
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Catchment Area (Health)
Female
Health Care Surveys
Health Services - utilization
Humans
Male
Mental disorders
Middle Aged
Quebec
Specialization
Urban Population
Young Adult
Abstract
The study was designed to identify factors associated with the diversity of professionals consulted by 212 individuals affected by at least one mental disorder in the past 12 months in a Montreal catchment area. For inclusion in the study, participants had to be aged 15 to 65 and reside in the study zone. A comprehensive set of variables were analyzed in accordance with the Andersen's behavioural model of health service use. General practitioners, psychiatrists, and psychologists were the main professionals consulted in this study. Having post-secondary education, more than a single mental disorder, excellent relationships with neighbours, and (marginally) being a lifelong victim of violence were associated with higher numbers of professionals consulted. As this study highlights the large number of diversified professionals consulted for reason of mental disorders, shared care initiatives may prove beneficial. Greater effort could also be made in increasing services toward those deemed more vulnerable.
PubMed ID
22980229 View in PubMed
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[The implementation of integrated networks of mental health services in Quebec: context of introduction, state of implementation and the views of general practitioners].

https://arctichealth.org/en/permalink/ahliterature126654
Source
Sante Publique. 2011 Nov-Dec;23 Suppl 6:S155-9
Publication Type
Article
Author
Marie-Josée Fleury
Author Affiliation
Departement de psychiatrie, Universite McGill, Montreal, Canada.
Source
Sante Publique. 2011 Nov-Dec;23 Suppl 6:S155-9
Language
French
Publication Type
Article
Keywords
Attitude of Health Personnel
Community Mental Health Services - organization & administration
Community Networks
General practitioners
Health Care Reform
Humans
Quebec
Abstract
This paper presents the emerging context of integrated service networks (ISN), clarifies the concept of ISN, and highlights some of the key factors in the successful implementation of ISNs. The Quebec healthcare reform illustrates the current state of development of integrated care. The main targets of the reform are the consolidation of primary care and the development of collaborative models of mental health care (or shared care). Since they are very complex to operate (insofar as they require major system changes), ISNs are not widely developed. General practitioners are at the heart of the current reforms since they have a key role to play in the successful implementation of integrated care models, including ISN models.
PubMed ID
22370080 View in PubMed
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[Mental healthcare system transformation: international tendencies and Québec-France perspectives].

https://arctichealth.org/en/permalink/ahliterature105686
Source
Sante Ment Que. 2013;38(1):17-41
Publication Type
Article
Date
2013
Author
Marie-Josée Fleury
Saïd Acef
Author Affiliation
Université McGill; Centre de recherche du Douglas Institut universitaire en santé mentale; FRQ-S, Centre de réadaptation en dépendance de Montréal - Institut universitaire.
Source
Sante Ment Que. 2013;38(1):17-41
Date
2013
Language
French
Publication Type
Article
Keywords
Delivery of Health Care - organization & administration - trends
France
Health Care Reform
Humans
Mental Health Services - organization & administration - trends
Quebec
Abstract
This article is an overview of international tendencies on current mental healthcare transformation. It describes best practices based models and strategies aimed at improving efficiency of mental healthcare systems. To illustrate reforms in Quebec and France, the article reviews current literature and ongoing research on mental health care and service organization. During the last decade, primary care reinforcement, including best-practices and service integration, has been at the core of the mental healthcare system transformation. However, challenges regarding implementation appear to undermine the transformation's success. This article discusses mental healthcare services planning in order to improve their efficiency and allow the transfer of knowledge acquired through these reforms.
PubMed ID
24336988 View in PubMed
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[Community trajectories of mentally ill and intellectually disabled young people].

https://arctichealth.org/en/permalink/ahliterature105367
Source
Sante Publique. 2013 Jul-Aug;25(4):453-63
Publication Type
Article
Author
Marie-Josée Fleury
Guy Grenier
Author Affiliation
Department de psychiatrie, Université McGill, 825, rue Sherbrooke ouest, H4H 1R3 Montreal, Canada. flemar@douglas.mcgill.ca
Source
Sante Publique. 2013 Jul-Aug;25(4):453-63
Language
French
Publication Type
Article
Keywords
Adolescent
Adult
Community Mental Health Services - statistics & numerical data
Disabled persons - statistics & numerical data
Female
Humans
Intellectual Disability - epidemiology
Male
Mentally Ill Persons - statistics & numerical data
Quebec - epidemiology
Young Adult
Abstract
In the context of reforms in the field of disability, this study documents the trajectories and mechanisms of support for young people with mental illness or intellectual disability or pervasive developmental disorders, during the teen-adult life transition period; andfactorsfostering or impeding this transition for their maintenance in an everyday environment, particularly in SESSAD (special education and home care service) and the SAMSAH/ SPAC (medico-social support for adults with disabilities/support services in social life).
This study was conducted in the French department of Seine-et-Marne. It was supported by a mixed call for tenders, in which 77 respondents (professionals, families and users), and 26 organizations were consulted.
The study shows that few young adults in SAMSAH/SPAC programmes are derived from SESSAD, and they encounter major difficulties living in an everyday environment, particularly during the transition period. Clinical or socio-economic factors related to the profiles of users or healthcare service organization facilitate or hinder the inclusion of young people in an everyday environment. Support for users was also often limited to followup over a suboptimal period, and was hampered by insufficient networking within the regional healthcare system. On the other hand, empowerment of users and their optimal inclusion in an everyday environment, as founding principles of the reform, constitute major action priorities for healthcare structures.
Strengthening services for young people (16-25 years), including integration strategies, is recommended in order to establish an integrated network of services in the field of disability.
PubMed ID
24404727 View in PubMed
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Typology of adults diagnosed with mental disorders based on socio-demographics and clinical and service use characteristics.

https://arctichealth.org/en/permalink/ahliterature135135
Source
BMC Psychiatry. 2011;11:67
Publication Type
Article
Date
2011
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Michel Perreault
Author Affiliation
Department of Psychiatry, McGill University, 845 Sherbrooke Street West, Montreal, Quebec, Canada, H3A 2T5. flemar@douglas.mcgill.ca
Source
BMC Psychiatry. 2011;11:67
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cluster analysis
Demography
Female
Health Surveys
Humans
Male
Mental Disorders - classification - diagnosis
Mental Health Services - utilization
Middle Aged
Socioeconomic Factors
Abstract
Mental disorder is a leading cause of morbidity worldwide. Its cost and negative impact on productivity are substantial. Consequently, improving mental health-care system efficiency - especially service utilisation - is a priority. Few studies have explored the use of services by specific subgroups of persons with mental disorder; a better understanding of these individuals is key to improving service planning. This study develops a typology of individuals, diagnosed with mental disorder in a 12-month period, based on their individual characteristics and use of services within a Canadian urban catchment area of 258,000 persons served by a psychiatric hospital.
From among the 2,443 people who took part in the survey, 406 (17%) experienced at least one episode of mental disorder (as per the Composite International Diagnostic Interview (CIDI)) in the 12 months pre-interview. These individuals were selected for cluster analysis.
Analysis yielded four user clusters: people who experienced mainly anxiety disorder; depressive disorder; alcohol and/or drug disorder; and multiple mental and dependence disorder. Two clusters were more closely associated with females and anxiety or depressive disorders. In the two other clusters, males were over-represented compared with the sample as a whole, namely, substance abuses with or without concomitant mental disorder. Clusters with the greatest number of mental disorders per subject used a greater number of mental health-care services. Conversely, clusters associated exclusively with dependence disorders used few services.
The study found considerable heterogeneity among socio-demographic characteristics, number of disorders, and number of health-care services used by individuals with mental or dependence disorders. Cluster analysis revealed important differences in service use with regard to gender and age. It reinforces the relevance of developing targeted programs for subgroups of individuals with mental and/or dependence disorders. Strategies aimed at changing low service users' attitude (youths and males) or instituting specialised programs for that particular clientele should be promoted. Finally, as concomitant disorders are frequent among individuals with mental disorder, psychological services and/or addiction programs must be prioritised as components of integrated services when planning treatment.
Notes
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PubMed ID
21507251 View in PubMed
Less detail

[Profiles of agencies serving the homeless or those at risk of homelessness in the region of Montreal].

https://arctichealth.org/en/permalink/ahliterature105683
Source
Sante Ment Que. 2013;38(1):119-41
Publication Type
Article
Date
2013
Author
Guy Grenier
Marie-Josée Fleury
Armelle Imboua
André Ngui
Author Affiliation
Institut universitaire en santé mentale Douglas, Montréal.
Source
Sante Ment Que. 2013;38(1):119-41
Date
2013
Language
French
Publication Type
Article
Keywords
Homeless Persons
Humans
Mental Health Services - organization & administration
Quebec
Risk factors
Abstract
This article presents a study of organizations serving people who are homeless or at risk of becoming homeless (PHRH) in Montreal, as well as the determinants of their inter-organizational relationships. The study shows that greater inter-organizational collaboration is needed, particularly within the network of health and social services (NHSS), to deal with the concomitant problems faced by PHRH. Among determinants that have an impact on the extent of inter-organizational relationships are the number of services offered, the appreciation of the relationships between organizations within the NHSS, and the ratio of Anglophones among the homeless and of individuals with gambling problems.
PubMed ID
24336993 View in PubMed
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Integrated service networks: the Quebec case.

https://arctichealth.org/en/permalink/ahliterature168279
Source
Health Serv Manage Res. 2006 Aug;19(3):153-65
Publication Type
Article
Date
Aug-2006
Author
Marie-Josée Fleury
Author Affiliation
Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Verdun (Quebec), Canada. flemar@douglas.mcgill.ca
Source
Health Serv Manage Res. 2006 Aug;19(3):153-65
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - organization & administration
Delivery of Health Care, Integrated - organization & administration
Health Services Research
Humans
National health programs - organization & administration
Organizational Case Studies
Quebec
Abstract
In the current context of health-care reform, integrated service networks are presented as main solutions to enhance efficiency. During the past few years, there has been an abundance of literature focusing on integration and the underlying implementation issues. However, the concept of integrated service networks remains fluid, and there are few typologies on health-care inter-organizational relations. The Quebec health-care system offers fertile ground for furthering our understanding of this concept because of its public system of funding, its integration of health and social missions, and the present reform's state of development. On the basis of a review of the literature and empirical studies, this article intends to clarify the concept of integrated service networks. A typology of inter-organizational relations and the main parameters for organizing integrated service networks are presented. The article also discusses the effectiveness of integration models.
PubMed ID
16848956 View in PubMed
Less detail

Factors associated with needs of users with severe mental disorders.

https://arctichealth.org/en/permalink/ahliterature118281
Source
Psychiatr Q. 2013 Sep;84(3):363-79
Publication Type
Article
Date
Sep-2013
Author
Marie-Josée Fleury
Guy Grenier
Jean-Marie Bamvita
Jacques Tremblay
Author Affiliation
Douglas Hospital Research Centre, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada. flemar@douglas.mcgill.ca
Source
Psychiatr Q. 2013 Sep;84(3):363-79
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cross-Sectional Studies
Female
Health services
Health services needs and demand
Humans
Interpersonal Relations
Male
Mental Disorders - psychology - therapy
Middle Aged
Patient satisfaction
Questionnaires
Retrospective Studies
Self Report
Social Support
Suicide - psychology
Abstract
For persons suffering from severe mental disorders (SMD), better quantification of needs may facilitate services planning and evaluation, as well as patient recovery. This study aimed to assess associations of sociodemographic, socioeconomic, service utilization, life events, social support and clinical variables with the level of perceived needs of users with SMD globally and according to their factorial structure. A total of 351 adults with SMD from Montreal (Canada) were interviewed using the Montreal Assessment of Needs Questionnaire and seven other standardized instruments. Clinical records were also consulted. Eight variables were associated with levels of needs. Four factors were extracted from the factor analysis and labeled respectively: Helplessness, Social Integration, Functional Skills and Interpersonal Relationships. Models built from needs assessment factors are stronger than global needs and have a greater association with pertinent variables. Linear regression models based on factors show the importance of satisfaction with life domains and substance abuse in association with higher levels of perceived needs. The recognition of variables associated with each factor would optimize care planning and implementation.
PubMed ID
23224403 View in PubMed
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