This inventory of the functioning of local mental health councils (CLSM) (1) carried out in 2022 confirms trends already observed in 2018 and highlights notable developments, rich in lessons and giving rise to many reflections.
As noted in 2018, the CLSMs are rather young bodies, developed mainly in urban areas, supported by local authorities, and initiators of various actions in terms of promotion, prevention and management of mental health. They are still actively supported by the local authorities and the ARS, which are the main funders of the coordination positions. The main change relates to the territories covered: the population basins are larger, the perimeters tend to be defined more on the basis of intermunicipalities.
Their functioning is generally in line with the 2016 instruction: the 4 actors who constitute the basis of the CLSMs (elected officials, representatives of public psychiatry, users, caregivers) are present in the various bodies (steering committees, plenary assemblies) and in working groups, and their participation is generally considered to be active.
The CLSMs are also well inscribed in the territorial landscape of health coordination systems, commonly articulated with the CLS (local health contract), the PTSM and the ASV, a specific system of urban policy. On this point, we observe that CLSMs pay particular attention to territories covering QPVs (priority neighborhoods for urban policy), by carrying out local partnership work with key players and by implementing actions specific.
However, this analysis leads to several reflections:
– Despite the institutionalization of the approach in 2016 and the creation of a National Resource and Support Center in 2017, the number of CLSMs created each year does not increase. It is likely that the first two years of the Covid-19 crisis partly explain this observation, but another explanation might come from the difficulties for the territories to invest in the question, for several reasons (human, financial, beliefs, etc).
– For CLSMs in operation, there are also obstacles, already existing in 2018, impacting the effective implementation of their objectives: these obstacles are linked in particular to the financial investment – financing of
disparate coordination positions, insufficient coordination time, absence of own budgets – and the investment of certain key players – non-systematic participation of users and caregivers,
low representation of child psychiatry, insufficient involvement of municipal delegations associated with the many determinants of health.
These are all subjects on which the National Center for Resources and Support for the CLSM continues to work through its missions of methodological support, coordination of networks of actors and advocacy promoting the CLSM approach.
(1) Local mental health councils (CLSM) are forums for consultation and coordination bringing together local elected officials, representatives of public psychiatry, users of mental health services and their caregivers, and any player in a territory closely concerned. or far from sanity
