Patient, primary care provider, and health system factors associated with the use of centralized referral mechanisms implemented to improve patient access to specialized mental health services in Quebec

Accessing specialized mental health (MH) services via primary care is an important public health priority, especially in the pandemic context where psychological distress has increased amid the backdrop of already difficult access to MH services. The Quebec government implemented centralized referral mechanisms (Centres de répartition des demandes de services (CRDS)) to support family physicians (FPs) in referring patients to specialized MH services via primary care. CRDS are single regional access points for processing requests to specialized health services, yet to be evaluated. Psychiatry was one of the last specialties included in the CRDS (2019). Given that it was implemented in the backdrop of already used MH referral mechanisms by FPs (e.g., Guichet d'accès en santé mentale), we hypothesize that FPs' choice of referral system is related to individual and health system factors, as well as patient socio-demographic and clinical characteristics. With this project, we will: 1) better understand the functioning and implementation of the CRDS for psychiatry and its complementarity with existing referral mechanisms; 2) explore how FPs refer patients to specialized MH care and factors influencing their choice in referral mechanisms; 3) assess patient factors associated with target delay achievement when referred to specialized MH services; and 4) explore patient perceptions of their trajectories to specialized MH care and factors influencing these perceptions. This mixed methods project will rely on qualitative interviews with regional decision-makers, FPs, and patients from four Quebec regions: Montérégie-Est, Laval, Chaudière-Appalaches, and Montréal, as well as data on referral indicators from the study regions. Findings will be useful in Quebec, Canada (which has yet to implement such centralized and regional MH referral mechanisms), as well as other countries aiming to decrease consultation times to specialized MH services during and after the COVID-19 pandemic.