AMPQ releases action plan

In this regional news piece, Dre Taline Bedrossian and Dre Paola Habib (Québec Representatives on the CACAP Board of Directors) summarize a recently-developed « action plan » from the Association des Médecins Psychiatres du Québec (AMPQ):

Like many of our colleagues across the country, we have noticed an increased mental and emotional distress among children, adolescents and their families in the province of Quebec. The strict lockdowns, school closures, lack of extra-curricular activities and all the other restrictions in school and daily life due to COVID-19 exacerbated numerous problems lived by young ones while highlighting many accessibility and organizational problems in the health care systems.

Therefore, in March 2021, the child and adolescent psychiatry subcommittee in the AMPQ (Association des Médecins Psychiatres du Québec) published on their website an action plan for the provision of psychiatric services for children and adolescents, including some recommendations for the transition to adulthood.

The document presents the challenges at many levels and brings up some suggestions that aim for better health care for this population. We decided to share this document as we hope it could be helpful to other provinces across Canada.

The guiding principles highlighted in the document are accessibility, fluidity in services, and early intervention. Also, the document defines some commonly used terms. For instance, the term « mental health » was defined as a broader term that describes the well-being of a person emotionally, physically and socially; whereas the term mental disorder was seen as a dysregulation of thoughts, emotions and behaviour, bio-psychosocial in nature, and causing a loss of functionality.

The importance of prevention is the highlight of this document. Primary prevention should start as early as  daycare and continue with specific curricular courses in school. Like many provinces, Quebec added a sexual education class to its curriculum starting as early as elementary school. In addition, the AMPQ suggests to add  an introductory course to mental health concepts and terminology to the curriculum as well as a social and emotional skills class (SEL-Social and Emotional Learning) which would increase the children’s/adolescents’ resilience and coping strategies. Also, increasing school professionals/resources will help youth to have access in a timely fashion to services. In addition, many children and adolescents are waiting for specialized services to get a diagnosis in order to have access to services. The main recommendation would be to focus on children and adolescents’ school needs rather than focusing on a diagnosis. Each child and adolescents is different even with the same diagnosis, so the focus should be centred on patient needs.

As for second-line services, many physicians and professionals have difficulty accessing those services, because of lack of clarity and availability. Therefore, having one phone number (guichet d’accès santé mentale) with one form would facilitate referrals as well as access to care. This way of working will allow a more fluid interaction among the different teams involved in mental health.

Shared-care models, working as a consultant to the first-line teams including family physicians and pediatricians has been very helpful in many areas in order to provide care to the patients through the indirect consultations done by the specialist and also by providing a transfer of knowledge to professionals and primary care physicians. This should continue to be encouraged in places where it is not offered.

Also in second-line services, since there are not enough child and adolescent psychiatrist across the country, one of the recommendation would be to allow general psychiatrists to work with children and adolescents and not limit those positions to the subspecialists until there are more graduates. This could relieve the burden in regions that often have a harder time recruiting subspecialists.

As for third-line services, they should be available in a very timely fashion to second-line services for treatment resistant pathologies and therefore give support to the involved physicians and professionals with a stabilization period or specific recommendations.

Finally, the importance of rehabilitation services and developing them with more human resources should be prioritized. Children/adolescents with autism spectrum disorder, intellectual disabilities and physical disabilities require regular services and help in their daily life, as well as respite for the families. Therefore, this will allow a more patient-centred approach and would avoid unnecessary intensive interventions, including pharmacologic interventions.

Access to the full article and recommendations can be found at the following link:

Thank you to the AMPQ child and adolescent psychiatry subcommittee for their exceptional work and for their willingness to share this document.