Background. In the province of Québec, Canada, hospitals, local community medical service centers (CLSCs) and community organizations receive global budgets from which services to the mentally ill are provided. Parameters specifying how the three types of organizations may organize community services for the mentally ill are very broad. As ACT-like and other case management services are expanded, the three types of organization are vying for the mandate and budgets to provide these services. Objectives. The objective of this analysis is to discuss how, in this particular institutional context, case management services should be organized to best serve the severely mentally ill. Methods. Provincial- and regional-level documents pertaining to the provision of case management services were analyzed in the light of the existing literature on optimal organization of ACT/case management services. Extensive quantitative and qualitative client- and program-level data were collected at two hospital-based ACT or ACT-like programs, and two community organization-based programs, all in Montreal. Results. Wage disparities between institutional and non-institutional sectors, together with shortages of medical personnel, render the direct provision of any medical services by community organizations almost impossible. This heightens the contrast between the services that can be provided by one sector versus the other. The case study data examined suggest that there is nonetheless considerable overlap in the characteristics of the clienteles served by the different types of programs. Conclusions. More clearly defined and mutually exclusive admission criteria are required for the different types of programs to offer complementary services in the most cost-effective way.
Learning Objectives: Discuss how, in a Canadian context, case management services should be organized to best serve the severely mentally ill.
Keywords: Case Management, Mental Health Services
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.