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Quality measures for primary mental healthcare: a multistakeholder, multijurisdictional Canadian consensus
  1. Paul Waraich1,
  2. Renée Sarojini Saklikar2,
  3. Denise Aubé3,4,
  4. Wayne Jones5,
  5. David Haslam6,
  6. Karen Hamill7
  1. 1CARMHA (Centre for Applied Research in Mental Health & Addiction), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
  2. 2Knowledge Transfer and Communications Consultant, Vancouver, Canada
  3. 3National Public Health Institute of Québec, Québec, Canada
  4. 4Research Group on Social Inclusion, Service Organization and Evaluation in Mental Health, Québec, Canada
  5. 5CARMHA (Centre for Applied Research in Mental Health and Addiction), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
  6. 6Collaborative Mental Health Care, Department of Psychiatry, University of Western Ontario, London, Canada
  7. 7Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, Canada
  1. Correspondence to Dr Paul Waraich, Burnaby Mental Health Services, 3935 Kincaid Street, Burnaby, British Columbia V6S 1Y6, Canada; paul.waraich{at}


Objective To develop quality measures using a consensus-based, multistakeholder process to improve delivery of mental health services within primary healthcare settings.

Methods A three-stage consensus model culminating in a two-round, modified Delphi postal survey ranking quality measures according to ‘actionability,’ relevance and overall importance.

Participants More than 800 people from all 10 provinces and three territories in Canada participated in the study, representing consumers/advocates, clinicians, academics and government decision-makers from regional, provincial and federal levels. A small group with expertise in First Nations and rural-setting health issues was also included, as well as international experts.

Results The top overall pan-Canadian measure was ‘Education about Depression.’ ‘Actionability’ was a key criterion for many of the top 30 measures. Fifty per cent of these measures focused on three major themes: depression, self-harm and access to a broader spectrum of treatment (such as outreach services and psychotherapy). Additional themes included the need for greater collaboration, respectful treatment of patients and families, and improved evaluation of patients. One-way ANOVA results indicated statistically significant differences (p <0.05) between academics, clinicians, consumers and decision-makers on approximately 5% of quality measure ratings. The majority (85% of the 5%) of these differences involved consumer stakeholders.

Conclusion A small set of specific consensus measures were identified through a rigorous, evidence-informed process. These measures can be used for system-wide changes or at the individual practice level. Although these measures have been developed within a Canadian context, the methodology utilised and the measures selected can be adapted elsewhere.

  • Primary healthcare
  • mental health
  • quality indicators
  • quality measures
  • quality improvement

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  • Funding Health Canada, Primary Health Care Transition Fund, Primary and Continuing Health Care Division, Health Care Policy Directorate, Health Policy Branch, 18th Floor, Jeanne Mance Building, Address Locator: 1918B Tunney's Pasture, Ottawa, Ontario K1A 0K9.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the University of British Columbia and Simon Fraser University.

  • Provenance and peer review Not commissioned; externally peer reviewed.