Reorienting Mental Health Systems: The Dynamics of Policy and Planning

The role of regional planning and management strategies in the transformation of the healthcare system

“…From what we observed, the formalization of exchanges seems to be an important condition for success for the formation of integrated service networks in systems where there are signi®cant inter-organizational con¯icts, a¯uidity of mandates between organizations and quite different organizational cultures (e.g. community/institutional; White and Mercier, 1991). Matrix-based organization ensures co-ordination between different organizations' services by developing procedures that facilitate this kind of co-ordination (e.g.…”

Mental health policy in quebec: Challenges for an integrated system

“…Leaving the matter of the definition of the responsibilities of the different actors to the "spirit of partnership," the government opened the door to local power struggles. These can result in the reproduction of the dominant position of certain types of resources and the eradication of the competition, as we have discussed elsewhere Mercier, 1991a and1991b;White, 1993b). On the other hand, these dynamics have also produced important resource development in many regions and real restructuring of some local mental health systems (White, 1993a and1993b).…”

“…The third phase of reform is symbolized by the adoption of the province's first official mental health policy in 1989-a result of government, professional, and community pressures for change (White and Mercier, 1991b). The government was concerned with cost control because, since the 1970s, mental health problems had become the second most common reason for hospitalization in Quebec and accounted for 20 percent of total hospitalization days and for 20 percent of the province's total health expenses.…”

Le choc des cultures : bilan de l’expérience de participation des ressources alternatives à l’élaboration des plans régionaux d’organisation de services en santé mentale

“…Nous avançons en effet que, loin d'amorcer le virage tant souhaité « de la biologie à la culture » (Comité de la santé mentale, 1985), ou encore le virage non moins souhaité du renforcement de la communauté, les PROS favorisent plutôt la logique technocratique, privilégient encore le modèle institutionnel et reconduisent telle quelle la logique sectorielle. Il n'y a pas eu réorientation, mais réorganisation (White et Mercier, 1990aet 1990b c) Le maintien du modèle institutionnel Comme nous l'avons mentionné, la constante dominante des PROS, c'est l'absence de débats de fond sur les pratiques. Dans de telles conditions, on ne s'étonnera pas que le modèle institutionnel et le pouvoir psychiatrique demeurent encore largement dominants.…”

“…4, n° 2, 1991 le social ou la seule solution acceptable est la récupération totale (White et Mercier, 1990aet 1990b, l'intégration « mur-à-mur», l'homogénéisation à tout prix et, partant, l'appauvrissement de la société globale. En ce sens, il nous faut contribuer à « civiliser le politique », c'est-à-dire à y faire pénétrer en force toute la dynamique de nouveaux rapports sociaux.…”