Patients are informed that they are being transferred to the 1st line by their clinical health care professionals, who use a well-established protocol to make the transfers. These staff members:

• First explain how the transfer process will work
• Act as a liaison between patients and their future medical teams
• Transfer patient records
• Set up the first appointment
• Ensure that the transition occurs under the best possible conditions

If necessary, a patient who is being followed at a Centre de santé et de services sociaux (CSSS) and whose mental health has deteriorated may receive care at the Douglas Institute until his or her condition becomes stable.

The great majority of Douglas patients live near the campus. Those who will be transferred will most likely be treated at one of the two Centre de santé et de services sociaux (CSSS) in the area: CSSS Sud-Ouest-Verdun or the CSSS Dorval-Lachine-LaSalle lien, or in another CSSS close to their home, or wherever their general practitioner is located.

The determining factors in transferring patients to a CSSS are the patient's place of residence and the location of the family doctor who will be providing mental health care. However, it is important to remember that the Health and Social Services Act has precedence over territorial considerations and makes it possible for people to choose their supplier of services.
 

The psychiatrists at the Douglas will increasingly have to play the role of consultant or 'répondant' to general practitioners and the Centres de santé et de services sociaux (CSSS)' team of 1st line mental health professionals. Already, Douglas psychiatrists are working with their CSSS partners a few hours a week. For example, they will be able to give an opinion on a psychiatric problem requiring special expertise.

One of the guiding principles of the Mental Health Action Plan (MHAP) is continuity and the permeability of borders between the various levels of service in order to support speedier access to care. Accordingly, when recourse is required to more specialized services, a patient could be referred to the 2nd or 3rd line (Douglas Institute). When he is restabilized, he will return to the 1st line team for follow-up.

Many patients who are currently treated at the Douglas Institute present stable profiles and/or have mental health problems that do not require the care and the services of a superspecialized institution in mental health (2nd or 3rd line). Such patients will from now on be treated by:

• Centres de santé et de services sociaux (CSSS)’ team of 1st line mental health professionals
• a general
• or both

The transfers started in January 2009 and are still ongoing.

The professionals at the Douglas are reviewing the files of all patients. Patients to be transferred will be sufficiently stable, with a mental health profile that does not require the superspecialized services of an institution such as the Douglas Institute.

The Centres de santé et de services sociaux (CSSS) are currently organizing their services and their teams of mental health professionals in accordance with the mandate conferred on them, which is to be the entry point for people suffering from mental health problems.
As always, patients who arrive at a CSSS first receive a psychosocial assessment to determine whether they should be sent to a general 1st-line service or whether they should consult the "guichet d'acces" that has been implemented as part of the reform.

The «guichet d'accès»
The reform demands that each CSSS installs a «guichet d'accès» for people suffering from mental health problems. The «guichet d'accès» is the first place where the person's needs will be evaluated. Professionals will then determine whether the person should:

• benefit from the services of the CSSS's team of 1st line mental health professionals
• be given rapid access to more specialized (2nd or 3rd line) services such as the Douglas Institute

Teams of mental health professionals in the CSSSs
In order to serve new mental health clients effectively, each CSSS will need to add mental health professionals to its team. Where will these professionals come from? Some will come from the Douglas. In fact, 50 Douglas professionals will be transferred to partner CSSSs to help create multidisciplinary 1st line mental health teams.

The role of the 1st line general practitioner
General practitioners have always treated patients suffering from minor to moderate mental health problems (50 to 60% of those who seek treatment for mental health problems do so with a general practitioner). The Mental Health Action Plan (MHAP) counts on their experience to play an increased role in the care and services offered to 1st line mental health clients. They will be supported by the CSSS's team of 1st line mental health professionals and/or 2nd and 3rd line psychiatrists, like the ones at the Douglas.