The current Bill 15, establishing Santé Québec, entails great risks for the services dedicated to the well-being of citizens, in particular populations in a context of vulnerability or living with social and health inequalities.
Social programs include general psychosocial services for the entire population: women who are victims of domestic violence, families in difficulty or people experiencing various adjustment or social integration problems (various traumas, job loss, social isolation, psychological distress, for example). They also include specialized services for troubled youth, people with physical or intellectual disabilities, autism spectrum disorder and people at risk of substance abuse, exposed to homelessness or whose mental health is threatened.
It should be remembered that social services are offered by interdisciplinary teams in people’s living environments, using a local approach adapted to needs. Quebec is the only province in Canada to have integrated health and social services within the same ministry. This choice has advantages since the psychosocial and well-being aspects are often closely linked to physical and mental health.
On the other hand, certain risks are inherent, particularly in terms of the clinical governance of social services and their ability to develop and adapt to the changing needs of the population. Often, these services are overlooked in favor of “more pressing” issues, including emergency room overcrowding, surgical waiting lists and access to family physicians.
The omnipresence in the public sphere of critical physical health issues primarily captures the attention of leaders, thus neglecting the support and development of social services and mental health, which tend to remain in the blind spot. Their importance returns to the forefront momentarily over the dramas that follow one another, unfortunately more and more often.
The void left by the disappearance in 2015 of associations of establishments in the social sector, which played a major role in improving practices, has never been filled since the Barrette reform. The relationship between university researchers and the “field” to develop Quebec practices on the basis of recent research data has also been weakened. The development of social services has been undermined within integrated structures. The hospital logic put forward in successive reforms, including Bill 15, does not suit them.
A suitable response
Centralization is contrary to good practice in social services, which requires a response adapted to people, in the community, in complementarity with a diversity of authorities and sectors.
Quebec society is going through a critical post-pandemic period with significant social problems: housing crisis, ecological crisis, inflation, rising family dramas, child deaths, street violence, aging population, social isolation and mental health problems. , to name a few. We must be able to rely on strong social services to meet the needs of citizens.
To begin with, it is important to ensure that social services have a place commensurate with their importance in the system of governance to come. We believe that amendments to the bill are necessary to strengthen the clinical governance of social services in the proposed new structure. It is not too late to correct the mistakes of previous reforms!