Table 2 Proposed model for MH providers’ financing

1. Prevention early in life

Bundled payment to the PC team for the follow-up of children at risk or with special needs during the two first years of life

1. Children registration on a central platform, including information/justification for being considered at risk or with special needs, using a diagnosis evaluation grid

2. Presence of a psychologist available for consultation in PHC practices

2. Early detection of mental health disorders

1. Adding an indicator in the P4P scheme for PHC practices, namely the “percentage of users in the key-ages of the PNSIJ who have effectively attended the vigilance consultations, according to the diagnosis evaluation grid”

2. Payment of an additional fee to GPs for each follow-up consultation including MH evaluation, using the diagnosis evaluation grid

The diagnosis evaluation grid must be subject to public discussion, revised, and subject to a large approval by GPs. The current grid, defined by the PNSIJ, includes several mental health recommendations for children and adolescents, related to emotional and behavioral disorders, psycho-affective and social development, and environment safety

3. Stepped collaborative model for depression

1. Adding an indicator in the P4P scheme for PHC practices, namely the “Proportion of users with depression whose condition has been diagnosed with PHQ-9 and treatment has been initiated in the adequate phase of the collaborative stepped care model”

2. Payment of a fixed monthly fee to compensate these reference physicians for the extra work

1. Nomination of a reference GP in the PHC team and a reference psychiatrist in the specialised MH team of catchment area, to enhance the collaboration between primary and specialised care

2. Presence of a psychologist available for consultation in PHC practices

4. Integrated community-based care for SMI patients

1. Implementation of a per period payment, according to which the hospital receives an annual payment for each patient registered with SMI, covering all healthcare services

2. The payment is completed by a P4P component

 A bonus (resp. penalty) for the hospitals in the lowest (resp. highest) decile of the distribution in terms of inpatient stays

 A bonus (resp. penalty) for the hospitals in the lowest (resp. highest) decile of the distribution in terms of post-discharge consultations up to 30 days after discharge

 A budget penalty in case the hospital does not contribute and update a national registry of SMI, specifically created within this new payment model

1. The payment is attributed to the MH department, which has full autonomy and responsibility in managing funds, being the residual claimant

2. The MH department disposes of community-based MH teams, with protocols with PHC practices, residential units, patients and families associations, rehabilitation units, nursing homes, social services, and local authorities