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Résumé :
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"Mental health care delivery systems are attempting to strengthen the care supply within users' social environment (community care) and simultaneously to reduce the fragmentation of care delivery (care integration). Fragmentation particularly affects severely and chronically mentally ill patients with multiple and complex needs. These two aims may, however, appear to be in conflict, as fragmentation has been shown to be greater in community-based models of care. Mental health service networks have often been identified as an effective way of overcoming the issue of care fragmentation in community-based care systems. However, it remains unclear how networks should be designed and governed to address this specific issue. Our approach assumes that the structure of relations within service networks influences processes of collective action and outcomes at the user, service, and whole network levels. In three studies, we examined patterns of clinical and organisational relations between services, a tool for integrating care at the user level, and policy expectations in relation to care delivery networks. The research indicates that community care and integrated care require different patterns of relations between services, and in particular a model that favours density of ties or a model that favours the centrality of a specific agent. Moreover, there may be a conflict between clinical and organisational relationships, as well as between the needs of users and of the health system. Understanding these key factors may help to improve the organisation of mental health care delivery. They also suggest new perspectives in mental health service research and suggest tools that managers and policy-makers could use to monitor the implementation of service networks."
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