Table 1
Description of the three Mental Health (MH) Service Networks.
| Networks | Network 1 | Network 2 | Network 3 |
|---|---|---|---|
| Label | Metropolitan MH service network | Urban MH service network | Semi-urban MH service network |
| Area | Metropolitan and university | Urban and university | Remote |
| Population | 374, 655 | 311,455 | 75,807 |
| Proportion of population with low income | 21.5% | 4.5% | 10.0% |
| Proportion of single parent families | 38% | 19% | 21% |
| Adjusted average suicide mortality rate by 100 000 inhabitants | 14.9 | 20.4 | 16.0 |
| Government financial support for MH per inhabitant | 210.74 CAN$ | 207.67 CAN$ | 125.76 CAN$ |
| Percentage of financial support for MH community organisations | 7.0% | 8.9% | 11.0% |
| Primary care services | HSCCa (n = 2) LCSCb (n = 6) Medical clinics (n = 16) Adult primary care teams (n = 2) | HSCC (n = 1) LCSC (n = 7) Medical clinics (n = 59) Adult primary care teams (n = 3) | HSCC (n = 1) LCSC (n = 1) Medical clinics (n = 10) Adult primary care teams (n = 1) |
| Number of full-time professionals in MH primary care teams | 52 | 101 | 15 |
| Number of general practitioners | 240 | 456 | 106 |
| MH community based organisations | 30 | 40 | 12 |
| Psychologist for 10 000 inhabitants | 15.23 | 16.56 | 10.14 |
| MH specialized services | MH university Institute-psychiatric ERc (n = 1) Short-term care inpatient units (102 beds) Day hospitals (n = 3) Outpatient clinic Assertive community treatment Intensive case management Specialized clinics (n = 5) Psychosocial rehabilitation program | MH university institute- psychiatric ER (n = 3) Short-term care inpatient units (128 beds) Day hospital (n = 1) Outpatient clinic Assertive community treatment Intensive case management Specialized clinics (n = 3) Treatment centres in the community (n = 3) | General hospital-general ER (n = 1) Short-term care inpatient units (27 beds) Day hospital (n = 1) Outpatient clinic Assertive community treatment Intensive case management |
[i] a Health and social service center.
b Local community service center.
c Emergency room.
Figure 1
Conceptual Framework.
Table 2
Description of standardized instruments (MH professional questionnaire).
| Measures and references | Description | Cronbach’s Alpha Coefficients from the original validation | Cronbach’s Alpha Coefficients from the original validation in French and references |
|---|---|---|---|
| Recovery Oriented-Services [44] | 32 items; 5 sub-dimensions (life goals, involvement, diversity of treatment options, choice, individually-tailored services); (7 point scale); Higher = more positive | 0.76–0.90 | N/A |
| Team Interdependence [45] | 20 items; 3 sub-dimensions (task interdependence, resource interdependence, goal interdependence); (7 point scale); Higher = more positive | 0.77–0.88 | N/A |
| Team Support [46] | Team support; (7 point scale); Higher = more positive | 0.84–0.85 | 0.85 [47] |
| Team Autonomy [48] | 3 items; (7 point scale); Higher = more positive | 0.76 | 0.67 [49] |
| Involvement in the Decision-Making Process [48] | 3 items; (7 point scale); Higher = more positive | 0.88 | 0.80 [49] |
| Work Role Performance [17] | 18 items; 6 sub-dimensions (proficiency by the individual, proficiency by the team, adaptivity by individual, adaptivity by the team, proactivity by the individual, proactivity by the team; (7 point scale); Higher = more positive | 0.67–0.93 | 0.87–0.94 [47] |
| Conflict Between Co-Workers [50] | 9 items; 3 sub-dimensions (relationships, tasks, processes); (7 point scale); Higher = more negative | 0.93–0.94 | 0.84–0.91 [51] |
| Team Collaboration [21] | 14 items; 4 sub-dimensions (communication, synchronization, explicit coordination, implicit coordination; (7 point scale); Higher = more positive | 0.77–0.91 | 0.77–0.91 [21] |
| Job Satisfaction [52] | 20 items; 5 sub-dimensions (supervision, contingent reward, operating procedures, co-workers, nature of the work); (7 point scale); Higher = more positive | 0.60–0,82 | N/A |
Table 3
Description of standardized instruments (Service user questionnaire).
| Measures and references | Description | Cronbach’s Alpha Coefficients from original validation | Cronbach’s Alpha Coefficients from the original validation in French and reference |
|---|---|---|---|
| Drug Abuse Screening Test (DAST-20) [53] | 20 items; (2 point scale); Rating: 0 to 20; Higher = more negative | 0.92 | N/A |
| Alcohol Use Disorders Identification Test (AUDIT) [54] | 10 items; (5 point scale); Rating: 10 to 50; Higher = more negative | 0.80 | 0.87 [55] |
| Montreal Assessment of Need Questionnaire (MANQ) [56] | Seriousness of needs; 26 items; (11 point scale); Rating: 0 to 260; Higher = more negative | N/A | N/A |
| Adequacy of help received [57]; 26 items (quality and quantity); (11 point scale); Rating: 0 to 520; Higher = more positive | 0.91 | 0.91 [56] | |
| Alberta Continuity of Services Scale for Mental Health (ACSS-MH) [58] | 43 items; (5 point scale); Rating: 0 to 215; Higher = more positive | 0.78-0.92 | N/A |
| Recovery Assessment Scale (RAS) [59] | 41 items; (10 point scale); Rating: 0 to 410; Higher = more positive | 0.93 | 0.92 [60] |
| Satisfaction with Life Domains scale (SLDS) [61] | 20 items; (7 point scale); Rating: 0 to 140; Higher = more positive | 0.92 | 0,90 [62] |
Table 4
Two-step cluster analyses of structures, processes and outcomes in three mental health (MH) service networks. Summary of the main results.
| Structures Manager characteristics | Category 1 (n = 10; 22.2%) “Metropolitan network: primary care teams” | Category 2 (n = 9; 20.0%) “Metropolitan network: specialized MH teams” | Category 3 (n = 19; 42.2%) “Urban network: all teams” | Category 4 (n = 7; 15.6%) “Semi-urban network: allC teams” | |
|---|---|---|---|---|---|
| Settings | Metropolitan MH service network | Metropolitan MH service network | Urban MH service network | Semi-urban MH service network c | |
| Government financial support for MH per inhabitant | Highly positive | Highly positive | Positive | Highly negative | |
| Proportion of population with low income | Highly negative | Highly negative | Highly positive | Positive | |
| High emergency room (ER) users | Positive | Highly negative | Positive | Highly positive | |
| Frequency in use of clinical approaches | Highly negative | Positive | Positive | Highly positive | |
| Frequency in use of standardized clinical procedures and tools | Highly negative | Highly positive | Positive | Negative | |
| Organizational culture (Mean, SD) | Clan culture | Highly positive | Highly negative | Negative | Positive |
| Entrepreneurial culture | Highly negative | Positive | Negative | Highly positive | |
| Market culture | Highly negative | Highly positive | Positive | Negative | |
| Hierarchical culture | Highly negative | Positive | Positive | Highly positive | |
| Frequency of interaction with other teams and services (Mean, SD) (rating: 0–5) | Highly negative | Highly negative | Highly positive | Highly negative | |
| Frequency in use of integration strategies (Mean, SD) (rating: 0–5) | Positive | Highly positive | Highly negative | Negative | |
| Team processes MH professional characteristics | Category 1 (n = 92; 29.6%) “Metropolitan network: psychosocial professionals” | Category 2 (n = 112; 36.0%) Metropolitan and urban networks: senior medical professionals” | Category 3 (n = 69; 22.2%) “Urban network: psychosocial professionals” | Category 4 (n = 38; 12.2%) “Semi-urban network: all professionals” | |
| Sites | Mostly Metropolitan MH service network | Mainly Metropolitan MH service network | Exclusively Urban MH service network | Exclusively Semi-urban MH service network | |
| Professions | Mainly psychosocial professions | Mainly medical professions | Exclusively psychosocial professions | Mainly psychosocial professions | |
| Seniority in profession | Medium | Oldest | Old | Youngest | |
| Recovery-Oriented Services | Highly negative | Highly positive | Positive | Negative | |
| Team Interdependence | Highly negative | Highly positive | Negative | Medium | |
| Team Support | Highly negative | Highly positive | Negative | Positive | |
| Team Autonomy | Highly negative | Positive | Medium | Highly positive | |
| Involvement in the Decision–Making Process | Highly negative | Highly positive | Negative | Highly positive | |
| Work Role Performance | Highly negative | Highly positive | Negative | Medium | |
| Conflict Between Co-Workers | Highly negative | Positive | Positive | Highly positive | |
| Team Collaboration | Highly negative | Highly positive | Medium | Positive | |
| Job Satisfaction | Highly negative | Highly positive | Medium | Positive | |
| Outcomes Service user characteristics | Category 1 (n = 84; 25.7%) “Metropolitan network: middle-age men with positive outcomes” | Category 2 (n = 66; 20.1%) “Metropolitan network: older women with few MH problems” | Category 3 (n = 88; 26.9%) “Metropolitan and other networks: service users with complex MH problems and negative outcomes” | Category 4 (n = 89; 27.2%) “Urban and semi-urban networks: young service users with drug disorders” | |
| Sites | Exclusively Metropolitan MH service network | Exclusively Metropolitan MH service network | From the three networks | Urban and semi-urban MH service networks | |
| Gender | Exclusively male | Exclusively female | Mainly female | Mixed | |
| Age categories | Mainly 45–54 | Mainly 55 and over | Mixed | Mainly 18–44 | |
| Number of MH disorders | Positive | Highly positive | Highly positive | Positive | |
| Personality disorders | Highly positive | Highly positive | Highly negative | Positive | |
| Drug Abuse Screening Test (DAST) | Positive | Highly positive | Positive | Highly negative | |
| Alcohol Use Disorders Identification Test (AUDIT) | Highly negative | Highly positive | Negative | Positive | |
| Severity of needs | Highly positive | Positive | Highly negative | Negative | |
| Adequacy of help received | Negative | Highly negative | Highly positive | Positive | |
| Alberta Continuity of Services Scale (ACSS) for Mental Health | Highly positive | Negative | Negative | Negative | |
| Recovery Self-Assessment Scale (RSA) | Highly positive | Negative | Highly negative | Medium | |
| Quality of life (Satisfaction with Life Domains Scale – SLDS) | Highly positive | Positive | Highly negative | Negative | |
Table 5
Two-step cluster analyses of structures, processes and outcomes in three mental health (MH) service networks.
| Structures Manager characteristics | Category 1 (n = 10; 22.2%) “Metropolitan network: primary care teams” | Category 2 (n = 9; 20.0%) “Metropolitan network: specialized MH teams” | Category 3 (n = 19; 42.2%) “Urban network: all teams” | Category 4 (n = 7; 15.6%) “Semi-urban network: all teams” | Combined (n = 45; 10%) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | ||
| Settings (n., %) | Metropolitan MH service network | 10 | 100% | 9 | 100% | 0 | 0.0% | 0 | 0.0% | 19 | 1000 |
| Urban MH service network | 0 | 0.0% | 0 | 0.0% | 19 | 100% | 0 | 0.0% | 19 | 100% | |
| Semi-urban MH service network | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 7 | 100.0% | 7 | 100% | |
| Government financial support for MH per inhabitant | 125.8 CAN$ | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 7 | 100.0% | 7 | 100% |
| 207.7 CAN$ | 0 | 0.0% | 0 | 0.0% | 19 | 100% | 0 | 0.0% | 19 | 100 | |
| 210.7 CAN$ | 10 | 100.% | 9 | 100.% | 0 | 0.0% | 0 | 0.0% | 19 | 100% | |
| Proportion of population with low income (n., %) | 21.5% | 10 | 52.6% | 9 | 47.4% | 0 | 0.0% | 0 | 0.0% | 19 | 100% |
| 10.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 7 | 100.0% | 7 | 100% | |
| <5.0% | 0 | 0.0% | 0 | 0.0% | 19 | 100.0% | 0 | 0.0% | 19 | 100% | |
| High emergency room (ER) users (%, SD) | 20.0 | 27.1 | 39.3 | 27.5 | 27.8 | 26.4 | 12.1 | 15.3 | 25.9 | 26.1 | |
| Frequency in use of clinical approaches (Mean, SD) (rating: 0–10) | 5.5 | 1.7 | 6.1 | 1.8 | 6.1 | 1.8 | 6.4 | 2.4 | 6.0 | 1.9 | |
| Frequency in use of standardized clinical procedures and tools (Mean, SD) (rating: 0–42) | 24.9 | 4.3 | 29.4 | 5.7 | 28.4 | 5.5 | 25.4 | 5.5 | 27.4 | 5.5 | |
| Organizational culture (Mean, SD) (rating: 0–600) | Clan culture | 298.8 | 37.3 | 163.1 | 46.5 | 177.4 | 63.7 | 187.7 | 59.3 | 203.1 | 74.5 |
| Entrepreneurial culture | 111.6 | 31.3 | 122.2 | 27.9 | 113.8 | 34.5 | 124.6 | 53.2 | 116.7 | 35.2 | |
| Market culture | 66.1 | 19.3 | 148.8 | 21.0 | 117.9 | 38.5 | 89.1 | 46.0 | 108.1 | 43.5 | |
| Hierarchical culture | 131.8 | 33.5 | 196.0 | 71.1 | 198.4 | 47.0 | 213.9 | 87.2 | 185.5 | 63.0 | |
| Frequency of interaction with other teams and services (Mean, SD) (rating: 0–5) | 1.9 | 0.6 | 1.9 | 0.5 | 2.3 | 0.8 | 1.9 | 0.5 | 2.1 | 0,6 | |
| Frequency in use of integration strategies (Mean, SD) (rating: 0–5) | 3.0 | 0.6 | 3.1 | 0.6 | 2.6 | 0.5 | 2.7 | 0.6 | 2.8 | 0.6 | |
| Team processes MH professional characteristics | Category 1 (n = 92; 29.6%) “Metropolitan network: psychosocial professionals” | Category 2 (n = 112; 36.0%) “Metropolitan and urban networks: senior medical professionals” | Category 3 (n = 69; 22.2%) “Urban network: psychosocial professionals” | Category 4 (n = 38; 12.2%) “Semi-urban network: all professionals” | Combined (n = 311; 100%) | ||||||
| n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | ||
| Sites (n., %) | Metropolitan MH service network | 85 | 92.4% | 69 | 61.6% | 0 | 0.0% | 0 | 0.0% | 154 | 100% |
| Urban MH service network | 2 | 2.2% | 43 | 38.4% | 69 | 100% | 0 | 0.0% | 114 | 100% | |
| Semi-urban MH service network | 5 | 5.4% | 0 | 0.0% | 0 | 0.0% | 38 | 100% | 43 | 100% | |
| Professions (n., %) | Medical professions | 35 | 38.0% | 65 | 58.0% | 0 | 0.0% | 8 | 21.1% | 108 | 100% |
| Psychosocial professions | 53 | 57.6% | 26 | 23.2% | 69 | 100% | 21 | 55.3% | 169 | 100% | |
| General professions | 4 | 4.3% | 21 | 18.8% | 0 | 0.0% | 9 | 23.7% | 34 | 100% | |
| Seniority in profession (Mean, SD) | 8.3 | 10.1 | 10.4 | 11.4 | 9.5 | 11.4 | 5.4 | 7.8 | 8.9 | 10.7 | |
| Recovery-Oriented Services (Mean, SD) (Rating: 0–7) | 4.6 | 0.6 | 5.4 | 0.6 | 5.2 | 0.5 | 4.9 | 0.6 | 5.1 | 0.7 | |
| Team Interdependence (Mean, SD) (Rating: 0–21) | 12.3 | 3.0 | 15.1 | 2.7 | 13.3 | 3.1 | 13.6 | 2.9 | 13.7 | 3.1 | |
| Team Support (Mean, SD) (Rating: 0–7) | 4.3 | 1.1 | 5.4 | 0.9 | 4.5 | 1.2 | 5.1 | 1.1 | 4.8 | 1.2 | |
| Team Autonomy (Mean, SD) (Rating: 0–7) | 4.4 | 1.3 | 5.2 | 1.1 | 4.8 | 1.3 | 5.6 | 1.1 | 4.9 | 1.2 | |
| Involvement in the Decision–Making Process (Mean, SD) (Rating: 0–7) | 4.3 | 1.4 | 5.6 | 1.0 | 4.7 | 1.4 | 5.6 | 0.9 | 5.0 | 1.3 | |
| Work Role Performance (Mean, SD) (Rating: 0–42) | 32.9 | 3.0 | 36.3 | 2.8 | 34.0 | 3.1 | 34.9 | 3.0 | 34.6 | 3.2 | |
| Conflict Between Co-Workers (Mean, SD) (Rating: 0–21) | 10.3 | 3.7 | 8.4 | 2.4 | 8.9 | 2.5 | 7.6 | 1.5 | 9.0 | 2.9 | |
| Team Collaboration (Mean, SD) (Rating: 0–28) | 16.3 | 3.1 | 21.4 | 3.1 | 19.2 | 3.2 | 20.9 | 3.6 | 19.3 | 3.8 | |
| Job Satisfaction (Mean, SD) (Rating: 0–35) | 22.5 | 3.1 | 26.2 | 3.3 | 25.0 | 3.3 | 26.0 | 3.1 | 24.8 | 3.6 | |
| Outcomes Service user characteristics | Category 1 (n = 84; 25.7%) “Metropolitan network: middle-age men with positive outcomes” | Category 2 (n = 66; 20.1%) “Metropolitan network: older women with few MH problems” | Category 3 (n = 88; 26.9%) “Metropolitan and other networks: service users with complex MH problems and negative outcomes” | Category 4 (n = 89; 27.2%) “Urban and semi-urban networks: young service users with drug disorders” | Combined (n = 327; 100%) | ||||||
| n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | n/Mean | %/SD | ||||
| Sites (n., %) | Metropolitan MH service network | 84 | 100% | 66 | 100% | 43 | 48.9% | 0 | 0.0% | 193 | 100% |
| Urban MH service network | 0 | 0.0% | 0 | 0.0% | 31 | 35.2% | 45 | 50.6% | 76 | 100% | |
| Semi-urban MH service network | 0 | 0.0% | 0 | 0.0% | 14 | 15.9% | 44 | 49.4% | 58 | 100% | |
| Gender (n., %) | Female | 0 | 0.0% | 66 | 100% | 53 | 60.3% | 45 | 50.6% | 164 | 100% |
| Male | 84 | 100% | 0 | 0.0% | 35 | 39.8% | 44 | 49.4% | 163 | 100% | |
| Age categories (n., %) | 18–44 | 19 | 22.6% | 15 | 22.7% | 28 | 31.8% | 50 | 56.2% | 112 | 100% |
| 45–54 | 36 | 42.9% | 20 | 30.3% | 31 | 35.2% | 20 | 22.5% | 107 | 100% | |
| 55 and over | 29 | 34.5% | 31 | 47.0% | 29 | 33.0% | 19 | 21.3% | 108 | 100% | |
| Number of MH disorders (Mean, SD) | 1.5 | 0.8 | 1.4 | 0.7 | 2.7 | 1.0 | 1.6 | 1.1 | 1.8 | 1.1 | |
| Personality disorders (n., %) | 0 | 0.0% | 0 | 0.0% | 88 | 100% | 5 | 5.4% | 93 | 100% | |
| Drug Abuse Screening Test (DAST) (Mean, SD); (rating: 1–5) | 2.4 | 1.7 | 2.2 | 1.4 | 2.4 | 1.6 | 3.9 | 3.9 | 2.8 | 2.5 | |
| Alcohol Use Disorders Identification Test (AUDIT) (Mean, SD); (rating: 0-10) | 6.2 | 4.8 | 3.9 | 3.9 | 5.6 | 8.0 | 4.6 | 7.3 | 5.2 | 6.4 | |
| Severity of needs (Mean, SD) (rating: 0–260) | 38.9 | 26.5 | 39.3 | 24.5 | 60.0 | 33.0 | 53.4 | 35.2 | 48.6 | 31.7 | |
| Adequacy of help received (Mean, SD) (rating: 0–520) | 64.6 | 51.8 | 51.0 | 40.2 | 86.5 | 52.0 | 74.8 | 59.1 | 70.5 | 53.2 | |
| Alberta Continuity of Services Scale (ACSS) for Mental Health (Mean, SD) (rating: 0–215) | 136.3 | 17.5 | 131.5 | 14.5 | 130.8 | 16.1 | 130.6 | 15.4 | 132.3 | 16.1 | |
| Recovery Self-Assessment Scale (RSA) (Mean, SD) (rating: 0–410) | 168.2 | 25.1 | 163.6 | 17.7 | 162.3 | 20.2 | 164.2 | 28.0 | 164.6 | 23.4 | |
| Quality of life (Satisfaction with Life Domains Scale – SLDS) (Mean, SD) (rating: 0–140) | 102.0 | 16.3 | 99.2 | 17.8 | 90.9 | 20.2 | 95.3 | 18.7 | 96.6 | 18.8 | |