Implementation of the Consultation-liaison Model in Quebec and its Impact on Primary Care Providers

Background: With increasing resource scarcity in specialized mental healthcare, collaborative care models have been advanced in order to strengthen primary mental healthcare. The consultation-liaison model was introduced in conjunction with sweeping reform of the Quebec (Canada) healthcare system. Respondent-psychiatrists were hired to provide consultation and support to both general practitioners (GP) working in medical clinics and primary care MH teams. This study evaluates the impact of respondent-psychiatrists on the capacity of GPs and primary care teams to diagnose and treat MH disorders, and identifies barriers and facilitators to their deployment within the consultation-liaison model. Methods: Eleven local networks provided the setting. Data collection included structured questionnaires completed by 29 respondent-psychiatrists and 33 managers, and semi-structured interviews with 102 network stakeholders. Mixed methods were employed, triangulating data from questionnaires, interviews and network-related documents. Results: Respondent-psychiatrists collaborated more effectively with MH primary care teams than with GPs. Barriers to implementation of respondent-psychiatrists were identified, including poor comprehension of the model, inadequate provincial coordination, resistance from psychiatrists and GPs, lack of financial incentives for GPs, little knowledge of GP and patient needs in primary care, and physical distance between GPs and respondent-psychiatrists. Conclusion: Although respondent-psychiatrists positively impacted MH primary care teams, the consultation-liaison model as implemented did not fully meet needs among GPs who treat most MH problems. Implementation called for better model indicators and provincial-level coordination. A more comprehensive model of collaborative care including integrated MH teams and psychosocial care managers might optimize the use of GPs in primary mental healthcare.