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:
1) Service user stream: This area explores interactions among the socio-demographic, 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.
2) 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 data banks; 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, the team work implies the active participation of decision makers, clinicians and service users. The team also benefits from several sources of research funding.
For all questions on the research of this team, please contact:
Marie-Josée Fleury, PhD, Principal Investigator, firstname.lastname@example.org or
Guy Grenier, PhD, Associated Researcher, email@example.com
Fleury, M.-J., G. Grenier, Z. Cao, Meng, X. (2020). 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 more than 260 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 the 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., Associate Researcher
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
Béatrice Simo, Doctoral Student
Morgane Gabet, Doctoral Student
Dietta Chihade, Doctoral Student
Gaidas Firas, Masters Student
Pierre Smith, Student Intern
Met and unmet needs of homeless individuals at different stages of housing reintegration: A mixed-method investigation. PLoS One. 2021;16(1):e0245088.2021
A multilevel study of patient-centered care perceptions in mental health teams. BMC Health Serv Res. 2021;21(1):44.2021
Using administrative health data to estimate prevalence and mortality rates of alcohol and other substance‐related disorders for surveillance purposes.. 2021.2021
[Follow-up of Post-Transitional Housing for Homeless Women: Needs, Implementation and Outcomes of a Pilot Study]. Sante Ment Que. 2020;45(1):79-103.2020
Factors Related to 30-day Readmission following Hospitalization for Any Medical Reason among Patients with Mental Disorders: Facteurs liés à la réhospitalisation à 30 jours suivant une hospitalisation pour une raison médicale chez des patients souffr. Can J Psychiatry. 2020:706743720963905.2020
Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada. Health Soc Care Community. 2020.2020
Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res. 2020;20(1):854.2020
Determinants of suicidal ideation and suicide attempt among former and currently homeless individuals. Soc Psychiatry Psychiatr Epidemiol. 2020.2020
Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry. 2020;20(1):431.2020
Change in Housing Status among Homeless and Formerly Homeless Individuals in Quebec, Canada: A Profile Study. Int J Environ Res Public Health. 2020;17(17).2020
Typology of Currently or Formerly Homeless Individuals Based on Their Use of Health and Social Services. Community Ment Health J. 2020.2020
Relationships Among Structures, Team Processes, and Outcomes for Service Users in Quebec Mental Health Service Networks. Int J Integr Care. 2020;20(2):12.2020
Typology of patients who use emergency departments for mental and substance use disorders. BJPsych Open. 2020;6(4):e59.2020
Predictors of Frequent Emergency Department Utilization for Mental Health Reasons. J Behav Health Serv Res. 2020.2020
Editorial: Community-Based Outreach Treatment for Addictions and Concomitant Disorders: Time for a Change of Paradigm. Front Psychiatry. 2020;11:2.2020
Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend. 2020;207:107817.2020
Factors Associated with Perceived Continuity of Care Among Patients Suffering from Mental Disorders. Community Ment Health J. 2020;56(4):670-679.2020
Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada. Health Soc Care Community. 2020;28:22-33.2020
Portrait des troubles liées aux substances psychoactives: troubles mentaux concomitants et utilisation des services médicaux en santé mentale.; 2020.2020
Profils des patients utilisant les services de l’urgence hospitalière pour des troubles mentaux et des troubles liés à l’utilisation des substances.; 2020.2020
Le soutien postlogement transitoire auprès des femmes en situation d’itinérance : besoins, implantation et impact d’une étude pilote Follow-up of Post-Transitional Housing for Homeless Women: Needs, Implementation and Outcomes of a Pilot Study.. 2020;45:79.2020
Profiles of persons with current or previous experience of homelessness using emergency departments.. 2020:1-19.2020
Predictors of emergency department visits for suicidal ideation and suicide attempt.. 2020;285:112805.2020
Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness. Int J Environ Res Public Health. 2019;16(24).2019
Predictors of Number of Healthcare Professionals Consulted by Individuals with Mental Disorders or High Psychological Distress. Int J Environ Res Public Health. 2019;16(17).2019
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