The local mental health council (CLSM) is a platform for consultation and coordination between local elected representatives of a territory, public psychiatry, users and carers. It aims to define local policies and actions to improve the mental health of the population. From about fifteen operational CLSMs in 2005, to thirty in 2010 and more than 120 created in 2015 and some sixty in the process of being created, CLSM are slowly but surely spreading throughout the national territory.
The WHO has initiated a program to support the development and strengthening of CLSMs with the Interdepartmental Delegation to the City since 2008, then with the DGS and Acsé in 2012. This methodological support at the local level is complemented by the progressive constitution of a national network of CLSM which has taken shape since 2012 through the setting up of the National Meetings of CLSM, organized jointly by the association Public Health and Territories (PTSD) and WHO.
One of the missions of the WHO CCOMS is to identify at the national level the organizations that the CLSM take, and more specifically to identify the interesting and even innovative practices and to know the actors of the CLSM.
During these six years of helping and supporting local initiatives for the development of CLSM, several observations have been made:
- As the CLSMs are not governed by any law [3], the actors have a freedom in the organization and activity of the latter.
- The creation of a CLSM is possible in all territories but its efficiency and durability are difficult to implement.
- A hasty implementation and the lack of collective reflection of its members slow down its activity and may lead to stopping the process.
- A lot of time is needed to set up the partnership. When developing the creation project, which depends on the local actors and the specific situation of each territory, the members must debate to clarify the objectives that they want to reach collectively.
- There is a confusion between CLSM, which is a public health approach leading to concrete actions in the community and the cells of complex individual situations when they summarize the process.
- The place of user representatives is often not reflected before the creation of the CLSM. The identification of their needs and their expectations of local policies must be made from the outset, as well as a presentation and an explanation to the users of the importance of their participation from the beginning of the process.
Based on these observations, in 2012, the CCSO made recommendations to avoid these pitfalls. Recalling the foundations of the approach and the elements that promote dynamics and operational at the local level, these recommendations remain general and are of course not applied in all CLSM. Nevertheless, they influenced public decision-makers in their calls for projects for the dissemination of CLSM at the regional level and the local actors who wanted to launch their creation. While the current incentive-only framework of CLSM gives local actors flexibility in creation, it also leads to significant heterogeneity between devices. It was necessary to better understand this diversity. After 6 years of support from local actors, the WHO has made an inventory to identify their practices and activities. A questionnaire was developed and disseminated to the 81 operational LMCCs in November 2014.
About 20 CLSMs were created in the 2000s, following a mental health group from the city health workshop (ASV). ASVs were the precursors of CLSM [6]. These are the first platforms for consultation in health that have included the opinion of the inhabitants. Their creation in the early 2000s [7] allowed local communities to take up the health theme through social and territorial determinants. In 2013, mental health was one of the top three [8] topics addressed by ASVs. Nearly 70% of ASV LCMS have on the territory. Note that the two approaches are articulated by the participation of the ASV coordinator at CLSM (55%) or by a joint coordination for 15% of respondents. A coordinator explains that “the creation of the CLSM in 2012 was a continuation of the ASV diagnosis that had been carried out in 2008 and the actions implemented are consistent with the priorities that had been identified. This succession gives the city a real dynamism in the implementation of its health and social policy .
IMPACT OF THE LAW
More than 80% of the CLSM were set up after 2008 and the HPST law was an engine for their development. In 2010, the establishment of the ARS has amplified the need for disassemble of the health, medico-social and social sectors, from a public health perspective. The purpose of the ARS is ” to ensure a unified management of health in the regions, to better meet the needs of the population and to increase the efficiency of the system”(Law n ° 2009-879 of July 21st, 2009). The implementation of local health contracts (CLS) has been the occasion for an increased territorialisation of health policies and to act as closely as possible to the territory of life of citizens in the context of prevention in public health. Signed at the local level between local councilors and LRAs, they contribute to the emergence of a local health policy, including mental health. These contracts are efficient for the entire city, with health actions well beyond the ‘city politics’ neighborhoods. Thus, several CLS have integrated a CLSM action sheet, whether for its implementation, or to assert its role at the territorial level.
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