Améliorer la santé mentale des populations par l’intégration des soins de santé mentale aux soins primaires

Résumé

L’intégration des soins de santé mentale dans les soins primaires est une stratégie importante pour améliorer la santé mentale et le bien-être des populations. Dans la dernière décennie, le Québec a adopté plusieurs mesures pour renforcer les soins de santé mentale primaires, mais certains problèmes d’intégration persistent. Cette synthèse a été réalisée afin d’identifier et comparer les grandes initiatives internationales liées à l’intégration des soins de santé mentale aux soins primaires et de résumer les leçons tirées de ces initiatives qui sont pertinentes pour le Québec. Vingt initiatives ont été sélectionnées, décrites dans 153 articles et rapports. Trois initiatives portaient sur la santé mentale des jeunes, quatorze portaient principalement sur les adultes et trois autres initiatives portaient sur la santé mentale des aînés. La majorité des initiatives ont visé à implanter des modèles de soins de collaboration pour améliorer la gestion des troubles mentaux courants par les intervenants en soins primaires. Les initiatives ont été comparées sur les stratégies d’intégration adoptées, leurs effets, et les enjeux d’implantation rencontrés. Les leçons pour le Québec incluent le besoin de consolider davantage les soins en collaboration en santé mentale, de promouvoir des services informés par des processus d’amélioration continue de la qualité et de favoriser une plus grande utilisation des technologies qui soutiennent l’intégration.

Mots clés : soins intégrés, services de santé mentale, soins primaires, soins de collaboration, collaboration interdisciplinaire

Abstract

Improving population mental health by integrating mental health care into primary care

Objective The objectives of this review were to identify and compare major international initiatives aiming to integrate mental health services in primary care and to summarize the lessons learned for similar integration efforts in the province of Quebec, Canada.

Methods We conducted a narrative review of the literature guided by a conceptual framework drawn from the literature on integrated care. We identified relevant initiatives to support primary mental health care integration through Pubmed searches and through previous systematic reviews on this topic. We then selected those initiatives that provided sufficient details on their key characteristics, outcomes, and implementation issues (e.g. barriers, facilitators). We focused our analysis on large-scale initiatives as these offered the most potential for impacts on population mental health. This process resulted in the selection of 20 initiatives that were described in 153 articles and reports. Our synthesis was guided by our conceptual framework, which distinguishes between five types of integration, namely clinical, professional, organizational, systemic and functional integration.

Results Of the 20 primary mental health care integration initiatives, 3 targeted youth, 14 targeted adults or multiple age groups, and 3 were targeted towards seniors. Most initiatives aimed to implement collaborative care models for common mental disorders in primary care. Other initiatives focused on co-locating mental health professionals in primary care, supporting the emergence of a diversity of integration projects led by community-based primary care practices, or the merger of primary care and mental health organizations. Most initiatives were based on clinical, professional and functional integration strategies. Across initiatives, a range of positive outcomes were reported, notably to the accessibility and quality of services, the satisfaction of patients and providers, the costs of services, and impacts on patients’ health and quality of life. Integration initiatives encountered many common barriers to implementation. However, steps taken to properly prepare and execute the implementation process, as well as ensure the sustainability of initiatives, helped initiative leaders to overcome certain barriers. The lessons for Quebec include the need to continue to reinforce evidence-based models of collaborative mental health care in primary care and promote a culture of continuous quality improvement and a more widespread use of information technologies that can support integrated care.

Conclusion This review shows that integrating mental health services into primary care is a complex process that depends on a variety of strategies occurring at multiple levels of the healthcare system. However, it is also a unifying process that holds much potential to significantly impact the mental health and well-being of populations.

Keywords: integrated care, primary care, mental health, collaborative care, interdisciplinary collaboration, review

Remerciements

Les auteurs remercient Michèle Dugas pour son aide avec l’édition de ce manuscrit. Le stage postdoctoral de Matthew Menear est financé par les Instituts de recherche en santé du Canada.