- Division:Mental Health and Society
6875 Boulevard LaSalle
Researcher, Douglas Research Centre
Full Professor, Department of Psychiatry, McGill University
Organisation and adequacy of mental health services
Mental health problems affect at least 10% of the population in any given year; yet less than half of those affected utilize services for mental health issues. Their level of unmet needs is reportedly high, and varies according to type of needs, different mental health problems and individual profiles. Most notably, persons with mental health problems as well as alcohol and drug dependence, or those experiencing homelessness, have particularly important needs related to their global health, functioning, and activities of daily living; their social networks are often weak. As such, providing adequate help in order to respond to the needs of these individuals involves numerous challenges. Different models of care aimed at improving the efficiency of services, and at better serving individuals in the present context of increased service demand and budgetary restraint, have been progressively introduced with the overall objective of promoting a culture of best practices and continuing improvement in service delivery. These reforms have especially contributed to the consolidation of primary care, the provision of services in the community, and the integration of health care structures.
The research team on the organization and adequacy of services aims to better understand the needs of persons affected by mental health problems, abuse and dependence on psychoactive substances, and those in situations of homelessness, as well as the transformations and key components that may contribute to improving the delivery of care. By providing new findings on the determinants of needs, on service utilization as a function of different service user profiles, and on the organization and processes of care, the team hopes to improve the state of knowledge and to offer recommendations that will optimize mental health services.
Research initiatives undertaken by the team are organized along two major streams:
- Service user stream: This area explores interactions among the sociodemographic, economic, and clinical characteristics of service users; the evaluation of their met and unmet needs; help received; service utilization, as well as users’ degree of satisfaction with services. The objective is to better understand service trajectories and their impact on the community integration of services users as well as on their mental health recovery.
- Organizational stream: In the context of present reforms, this stream concerns the organization of services in local networks, their structuring, their dynamics, and practices employed. It aims to better understand organizational characteristics, modes of integration, and the efficacy of practices in terms of their contribution to improved performance, and to the overall quality of the system, notably in primary care and in specialized services including emergency services.
The team uses a variety of research methods: surveys, use of administrative databases; case studies, etc. The perspectives of managers, clinicians and service users are taken into account. While the team is composed of researchers and research agents with a variety of competencies, its work implies the active participation of decision makers, clinicians and service users. The team also benefits from several sources of research funding.
For any questions on the team's projects, please contact:
Fleury, M.-J., G. Grenier, Z. Cao, Meng, X. (2021). Typology of currently or formerly homeless individuals based on their use of health and social services. Community mental health journal. https://dol.org/10.1007/s10597-020-00693-6
Fleury, M.-J., M. Fortin, L. Rochette, G. Grenier, C. Huynh, E. Pelletier, H.-M. Vasiliadis (2019). Assessing quality indicators related to mental health emergency room utilization. BMC Emergency Medicine, 19(1): 8, https://doi.org/10.1186/s12873-019-0223-8.
Fleury, M.-J., L. Rochette, M. Fortin, A. Lesage, H.-M. Vasiliadis, C. Huynh, E. Pelletier (2019). Surveillance de l’utilisation des urgences au Quebec par les patients ayant des troubles mentaux (Report de recherche). Institut national de santé publique du Quebec (INSPQ), 21 p. https://www.inspq.qc.ca/sites/default/files/publications/2580_surveillance_utilisation_urgences_patients_troubles_mentaux.pdf
Fleury, M.-J., G. Grenier, C. Vallée, D. Aubé, L. Farand, J.-M. Bamvita, G. Cyr (2016). Implementation of the Quebec mental health reform (2005-2015). BMC Health Services Research, 16(1): 586.
Fleury, M.-J., J.-M. Bamvita, G. Grenier, N. Schmitz, M. Piat, J. Tremblay (2016). Adequacy of help received by individuals with severe mental disorders after a major healthcare reform in Quebec: Predictors and changes at 5-year follow-up. Administration and Policy in Mental Health, 43(5): 799-812.
Roux, P., C. Passerieux, M.-J. Fleury (2016). Mediation analysis of needs, service performance and outcomes for patients with mental disorders, British Journal of Psychiatry, Oct 6. pii: bjp.bp.116.184010.
Fleury, M.-J., A. Djouini, C. Huynh, J. Tremblay, F. Ferland, J.-M. Ménard, G. Belleville (2016). Remission from substance-use disorders: A systematic review and meta-analysis. Drug and alcohol dependence, Nov 1; 168: 293-306. doi: 10.1016/j.drugalcdep.2016.08.625. Epub 2016 Aug 29.
Chauvet, M., Kamgang, E., Ngamini Ngui, A., & Fleury, M.-J. (2015). L’Addiction aux substances psychoactives: Prévalence, utilisation des services et bonnes pratiques. Cahier de recherche du CRDM-IU, Montréal, 198 p.
Fleury, M.-J. & Brochu, S., Guest editors (2014). Special issue on addiction with co-occurring problems. Journal of Addiction Research Therapy, S10 (e001).
Fleury, M.J. in collaboration with Delorme, A., Guest editors (2014). Special issue on Politiques de santé mentale. Revue santé mentale au Québec (RSMQ), 39(1).
Fleury, M.-J., L. Farand, D. Aubé, A. Imboua (2012). Management of mental health problems by general practitioners in Quebec/La prise en charge des troubles de santé mentale chez les omnipraticiens du Québec. Canadian Family Physician, 58 (12): e732-738, e725-731.
Fleury, M.-J., Bamvita, J.-M., Farand, L., Aubé, D., Fournier, L. & Lesage, A. (2012). GP group profiles and involvement in mental health care. Journal of Evaluation in Clinical Practice, 18(2): 396-403.
Fleury, M.-J. & Grenier, G. (2012). État de situation sur la santé mentale au Québec et réponse du système de santé et des services sociaux. Québec, Commissaire à la santé et au bien-être.
Fleury, M.-J., & Grenier, G. (2012). Primary mental healthcare and integrated services. In L. L’Abate (Ed.), Mental illnesses. Evaluation, treatments and implications (pp. 357-390). Rijeka, Croatia: InTech.
Fleury, M.-J., M. Tremblay, H. Nguyen, L. Bordeleau (2007). Le système sociosanitaire au Québec. Régulation, gouvernance et participation. Montréal: Gaëtan Morin Publisher, 513 p.
Marie-Josée Fleury joined the research team at the Douglas Institute in 2002, after obtaining a doctorate in public health. She is Professor in the Department of Psychiatry at McGill University, and Adjunct professor in the School of Public Health at the Université de Montréal. She serves as consultant to the Quebec government as well as European government partners and research groups, especially in Belgium and France. From 2012-2016, she has been the Scientific Director at the Centre de réadaptation en dépendence de Montréal – University Institute, which brings together some 40 member researchers and associates. From 2010-2012, she also served as the mental health expert advisor in developing the 2012 appreciation report on performance of the Commission on Health and Welfare (CSBE) – Québec Health Ministry, which she authored with Dr. Guy Grenier: “Status report on mental health in Québec, and response of the health and social service system”.
She has published nearly 300 papers, and provided as many conferences. She also received salary awards from 2002 to 2014 (CIHR, FRQS), and has been awarded many research grants, including several for projects currently under her direction. Her research seeks a better understanding of key components for improving healthcare systems, and the adequacy of services in relation to the needs of service users, particularly in the areas of mental health, addiction, and homelessness. Her lines of research deal with health systems analysis, policy and service assessment, and implementation studies. She also conducts epidemiological and outcome studies.
FRQS, Senior Investigator Award, 2011-2014
CIHR, New Investigator Salary Award, 2006-2011
FRQS, Junior II Researcher Salary Awards, 2006-2010 (declined)
FRQS, Junior I Researcher Salary Award, 2002-2006
Guy Grenier, Ph.D., Research Associate
Armelle Imboua, M.D., M.Sc., Research Coordinator
Zhirong Cao, M.Sc., Research Agent
Judith Sabetti, Ph.D., Research Agent
Lia Gentil, Postdoctoral Fellow
Bahram Armoon, Postdoctoral Fellow
Morgane Gabet, Doctoral Student
Karine-Michèle Dion, Masters Student
Gaidas Firas, Masters Student
Pierre Smith, Student Intern