Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d’intervention précoce pour la psychose au Québec

Abstract

Introduction: Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. Methods: Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. Results: Half of Quebec’s population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient–clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. Conclusions: Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.

COVID‐19 pandemic's effects and telehealth in Early Psychosis Services of Quebec, Canada: Will changes last?

“…Moreover, EIS was widely implemented in the last few years across the province with governmental support (Bertulies‐Esposito et al, 2021 ; La Presse Canadienne, 2017 ; Ministère de la Santé et des Services Sociaux, 2020 ), which is not the case in many regions of the world. However, access to EIS remained a challenge in numerous remote rural areas, where EIS must sometimes cover up to 200 km around or are simply inexisting (Bertulies‐Esposito et al, 2020 ). Consequently, the situation described in this article might differ from contexts and experiences of other EIS across the world or to other types of mental health services.…”

“…The provincial EIS association— Association Québécoise des Programmes pour Premiers Episodes Psychotiques (AQPPEP)—founded in 2004, aims to promote and support the implementation of high‐quality and accessible EIS, through a community of practice, developing continuing education opportunities, raising awareness among the general population and policy makers alike through constant advocacy for youth suffering from FEP (L'Heureux et al, 2007 ). Currently, AQPPEP has 282 members (52 psychiatrists and 230 other mental health professionals including a few researchers), which are involved in one of the 33 EIS teams currently operating in the province (Bertulies‐Esposito et al, 2020 ).…”

The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis

“…Of note, in our 2016 study, 5/17 programs offered a 3-year follow-up and 10/17 offered follow-up periods of ≥5 years or longer (see Supplemental Table 1). 7 While all EIS offered services for first-episode psychosis, 14 offered ultra-high risk for psychosis (UHR-P) services as recommended by the Cadre. Fewer programs founded before 2017 offered UHR-P compared to 2016.…”

“…[2][3][4] While the availability of local guidelines alone is insufficient to ensure fidelity to core EIS components, 2,5,6 mentoring and implementation guidance from peer experts and a community of practice, fidelity audits, and policy and financial support could promote fidelity. [5][6][7][8] Despite lacking institutional and policy support, in 2016, Quebec's EIS offered high-quality services, while struggling with some administrative components. 7 In 2017, in line with recommendations from the Plan d'action en santé mentale 2015-2020, 9 Quebec's Ministry of Health and Social Services implemented four new measures: (1) commitment to developing EIS in every region, (2) additional recurring investments of $10 million/year dedicated to implementing and sustaining 15 new EIS, 10 (3) appointment of a specialist counsellor at the provincial Centre for Mental Health Excellence (CNESM), to support EIS implementation and quality improvement; and (4) publication of EIS standards, containing key performance indicators, 11,12 the Cadre de référence : Programmes d'intervention pour premiers épisodes psychotiques 11 (the Cadre).…”

“…[5][6][7][8] Despite lacking institutional and policy support, in 2016, Quebec's EIS offered high-quality services, while struggling with some administrative components. 7 In 2017, in line with recommendations from the Plan d'action en santé mentale 2015-2020, 9 Quebec's Ministry of Health and Social Services implemented four new measures: (1) commitment to developing EIS in every region, (2) additional recurring investments of $10 million/year dedicated to implementing and sustaining 15 new EIS, 10 (3) appointment of a specialist counsellor at the provincial Centre for Mental Health Excellence (CNESM), to support EIS implementation and quality improvement; and (4) publication of EIS standards, containing key performance indicators, 11,12 the Cadre de référence : Programmes d'intervention pour premiers épisodes psychotiques 11 (the Cadre). The CNESM specialist counsellor's role is to develop and launch training programs for EIS professionals and to support programs with operational or organisational challenges.…”