Evolution of policies
Until the 1960s, the majority of mental health problems were treated in mental hospitals. Operating essentially as a daycare service, they often took in several thousand “patients”, and offered very little in structured treatments. However, things changed very quickly as a result of several factors: the introduction of antipsychotics, the development of medical specialization programs in psychiatry and, above all, patients’ criticisms regarding their living conditions in these hospitals.
The Report of the Study Commission on Psychiatric Hospitals (1961-1962) resulted in an extensive deinstitutionalization movement that encouraged the development of community psychiatry and the establishment of psychiatric services in general hospitals, which required a variety of specialized disciplines, and a wider range of services. Since then, the mental health sector became the crucible of experience, and was replicated in other areas: the development of community resources, regionalization, protection of users’ rights and the creation of the Comité de la santé mentale du Québec (Quebec Mental Health Committee).
The committee’s work laid the foundation for the Mental Health Policy adopted in 1989. The majority of it was developed by partners working outside the government including clinicians and decision-makers as well as user, family and community representatives. This policy inspired a more general policy on health and social services, which included the same basic guidelines: importance of the individual, recognizing the role of community resources, partnerships, regionalization and delivery of services within the environment.
Despite the broad and innovative vision presented in this policy and the positive reaction it received, its implementation was more difficult than expected, and several large sections of the original project never saw the light of day. In 1998, following the review of its implementation conducted in 1995 to 1996, the ministère de la Santé et des Services sociaux proposed guidelines that, after consultation, led to the Plan d’action pour la transformation des services de santé mentale (Action plan for transforming mental health services). The document goes even further than the policy in focusing on services to people suffering from severe and persistent disorders. There is virtually no mention of transient disorders such as depression and anxiety, which affect a very large number of people, or activities related to health promotion and prevention, such as suicide prevention. It is in these particular areas that the Action Plan on Mental Health (2005-2010) stands out. The plan’s outline is briefly described in the March 2011 issue of Quintessence. The period covered by this plan is complete, and further guidelines are expected in the short term.