Toward a renewed, integrated and coherent vision for mental health, homelessness and addiction

Introduction

In order to address the issues of mental health, homelessness and addiction effectively, the Gouvernement du Québec would like to develop a vision in order to determine the future directions and the means to implement them. The aim of the call for input is to identify the directions and actions for the three themes (mental health, homelessness and addiction). So it is important to gather ideas and mobilize organizations, experts and citizens, and to hold a structured consultation in order to integrate their views when developing the future directions.

A call for input to develop the future directions in mental health, homelessness and addiction

The Québec population’s needs with respect to mental health, homelessness and addiction are increasingly complex and worrying. Issues of different kinds are observed that are leading to a significant increase in homelessness, an increase in and growing complexity of the needs of people who have a mental disorder or associated symptoms as well as the need for clinical addiction services. These issues, sometimes covered by the media, have consequences for these people, their loved ones and communities. They also pose major challenges for organizations and the Gouvernement du Québec, which must ensure equitable access to infrastructure and services adapted to their needs and their reality.

To address these issues and launch work on new directions in the three sectors, the Gouvernement du Québec must plan several actions to ensure the evolution and adequacy of its responses.

Therefore, it would like to co‑construct a renewed vision of its action and evaluate avenues for integrating some of the programs offered in these three sectors. To prevent and reduce these issues, it is necessary to have structuring, integrated or specific directions, and complementary means to implement.

What is service integration

Service integration can be defined as a coherent set of methods, processes and organizational and clinical models. It is based on collaboration between partners from different backgrounds, who act in a concerted way to support people affected by issues related to mental health, homelessness and/or addiction. The goal is to support their well‑being by acting on several areas of their lives. It implies a shared vision of the roles and responsibilities of the actors in society (for example, ministries, agencies and organizations, as well as the people concerned and their loved ones) and requires collaboration between them. Integration aims to meet the needs of users, their families and their loved ones more effectively. It must be considered as the combined result of the mechanisms of an integrated service network and the collaboration of all those concerned in their implementation. Coordination between all public, private and community partners is central to the actions that must be undertaken to ensure an optimal trajectory of services for the person.

More specifically, these modalities aim to ensure the creation of conditions and an environment conducive to the delivery of a personalized, equitable, effective and efficient continuum of services in response to the needs of people living with mental health, addiction and/or homelessness issues. It is a matter of considering the person as a whole and responding to their needs in various areas of their life.

Service integration and a holistic vision of the person have been objectives for many years. Integrating the mental health, homelessness and addiction sectors would make it possible to develop and implement their complementary governance, for the benefit of the main people who are or who could be concerned and their loved ones[1].

The growing complexity of the issues and the possible concomitance of mental disorders or associated symptoms, addiction and/or homelessness issues are prompting the Gouvernement du Québec to implement directions that take greater account of this reality[2]. For example, a survey of people who were experiencing homeless during the Nationally Coordinated Point‑in‑Time Counts shows that 74% of respondents reported experiencing problems with mental health or substance use[3]:

“Some co‑occurring problems are particularly common, such as the presence of an addiction and a mental disorder. By way of illustration, it appears that in 2020‑2021, of the various service users who were assessed with a view to receiving specialized addiction services in the health and social services network (HSSN), 58% had a mental disorder, diagnosed or not."[4]

In addition, the frequent overlap between issues related to mental health, homelessness and addiction highlights the fact that, sometimes, the needs of the people concerned are not limited to a single sector of intervention, but can also affect several essential dimensions of their lives. For example, they may face issues related to income, housing, well‑being, employment, education, immigration or integration and safety, which can increase psychological distress or substance use, or weaken residential stability. Conversely, issues related to mental health, homelessness or addiction can themselves lead to or aggravate situations of precariousness in these spheres. This reality requires a concerted, integrated and tailored response from the machinery of government.

Therefore, it appears necessary to adapt services to take all the needs of individuals into account. Thus the person as a whole, and all dimensions of their life, will be central to the vision of the future directions.

It is also a unique opportunity for the Gouvernement du Québec to carry out work that takes into account the interrelation and complexity of these social issues, in order to respond adequately, effectively and coherently to the needs of the population[5]. It is essential to rely on the principles of collaboration and complementarity to offer services that take greater account of this reality. More specifically, integration is imperative to:

• coordinate the organization of services in response to mental health, homelessness and addiction needs
• promote collaboration among the actors involved
• improve the coherence and relevance of these services
• increase the fluidity of services, especially in terms of access and continuity, in order to meet the needs of service users and their loved ones
• improve the quality of services
• optimize the efficiency of the system for users and their loved ones[6]

It is also important to clarify that the notion of integration that may be linked to mental health, homelessness and addiction is not intended to avoid any distinction as to the specificity of each. Rather it aims to promote consideration of the needs of the people concerned so as to offer coherent and tailored services, promoting comprehensive care.

That said, the particularities of each of these sectors (mental health, homelessness and addiction) must also be taken into account. a person may have needs only in one area and an integrated response may not be necessary or desirable.

In this sense, integration should, above all, serve to engage all actors in dialogue for the response to concomitant needs, but without standardizing approaches, in order to preserve the quality, relevance and effectiveness of responses tailored to the different realities of each person.

Mental health

Health is defined as “[…] a state of complete physical, mental and social well‑being and not merely the absence of disease or infirmity”[7]. Thus mental health is a component of health. It “corresponds to a state of well‑being that allows a person to overcome the obstacles of life, to realize their potential, to be productive and to participate in the life of their community”[8]. The determinants of mental health are many. They can be emotional, social, environmental and genetic. The term “mental disorder” refers to a “state of health that is characterized by the alteration of thought, mood or behaviour, which disrupts the functioning of the person and leads to distress. a person may have one or more mental disorders, conditions or diseases at a time”[9].

Current data indicate that all people, of all ages, will be directly or indirectly affected by mental illness, whether for themselves or for someone close to them[10].

The pandemic and the associated socioeconomic impact have contributed to increasing the psychological distress of the population. A number of studies[11, 12, 13] on the consequences of the pandemic on Quebecers’ mental health show that certain population groups have been particularly affected (young people, health workers, women, people in precarious situations, people with a pre‑existing mental disorder, for example). This situation is contributing to the growing psychosocial needs of the population.

Other more recent studies[14, 15] confirm that the current economic situation (the rising cost of living, inflation, economic tensions, etc.) is having a direct effect on the mental health of the population, increasing their psychological distress. For example, a national survey[16] reports that the cost of living is the primary source of anxiety for 52% of respondents, with women and low‑income people being the most affected.

Clinical‑administrative data and recent studies reveal that[17]:

• a person’s likelihood of developing a mental disorder in their lifetime is the norm rather than the exception. Each year, nearly 20% of the Québec population (1 in 5 people) experiences a mental disorder
• mental disorders appear early in life, before the age of 14 in 50% of cases and before the age of 22 in 70% of cases. Serious mental disorders such as schizophrenia or bipolar disorder often appear at a young adult age and affect about 2% of the population
• some rates doubled during the COVID-19 pandemic, including the prevalence of symptoms associated with depression and anxiety in children and teenagers. According to the Institut national d’excellence en santé et services sociaux (INESSS), these symptoms were the cause of half of emergency department visits by young Quebecers aged 12 to 17 in 2021
• anxiety disorders and depressive disorders accounted for nearly 65% of mental disorders diagnosed in Québec in 2009‑2010
• in 2023‑2024, the prevalence of anxiety‑depressive disorders in Québec was 6.1%[18]

Examples of mental health actions

Several initiatives have been put in place to respond to the significant increase in demand for mental health services in Québec. Resources are being mobilized to help people experiencing difficulties and actions are being carried out to support the resolution of these issues, including many structuring actions set out in the Plan d’action interministériel en santé mentale (PAISM) (in French only). These actions include:

• the improvement of primary care services and psychosocial consultation services provided to the general population (e.g., Info‑Social 811)
• the improvement of access to services by putting more effective mental health access mechanisms in place that allow users to obtain services without going through a doctor and without needing a diagnosis
• the e‑mental health strategy, which aims to put a more intuitive and user‑friendly service offer in place for the population, thus improving access to mental health care and services. It promotes the autonomy of people and their recovery and makes it easier to reach people who do not consult out of fear, in particular, of being stigmatized
• Aire ouverte or “open space” which, through a network of integrated youth services, including community organizations and other intersectoral and intra‑institutional partners, aims to provide comprehensive health care and services to young people aged 12 to 25, especially those who are reluctant to use the services of the HSSN. These services are tailored to young people’s needs and are offered without eligibility criteria, on a walk‑in or appointment basis, on a flexible schedule and without a wait list
• the implementation of alternatives to hospitalization that aim to prevent or shorten the length of hospital stay of users with a mental disorder or associated symptoms. This measure responds to the observation that hospitalization is sometimes described by service users as a negative, stigmatizing experience that slows down the recovery process if it is extended
• the development of a mental health information kit for immigrants aimed at informing them and meeting their needs in terms of awareness and access to mental health assistance, as well as facilitating their integration and full participation in Québec society
• mental health promotion and anxiety prevention in schools
• the creation of a regional support fund for cultural projects designed to have a positive effect on young people’s mental health
• the development of training for employers to promote the hiring, integration and retention of workers with mental disorders or associated symptoms in order to support people’s mental health, especially for their professional career

Homelessness

People experiencing homelessness face significant difficulties in several areas of their lives. They enter into a process of social disaffiliation that can go as far as a situation of social rupture. Their social safety net gradually disappears until they find themselves unwillingly banished from society. To reverse this process, it is important to stabilize their living situation and support the rebirth of a sense of empowerment and belonging. This takes time and requires support so that the person can go through this difficult process, fraught with obstacles, at their own pace.

In this perspective, it must be stressed that there is “a place for everyone”, which requires mobilizing the actors involved in the (re)affiliation of people who are experiencing homelessness or who are at risk of becoming homeless. It is imperative to take an intersectoral approach that takes all areas of life into account and aims at both prevention and support.

Several factors contribute to the phenomenon of homelessness. They include:

• the shortage of affordable housing and the use of emergency and transitional housing: in its Rental Market Report, the Canada Mortgage and Housing Corporation revealed that the vacancy rate of rental apartments decreased in 2022. In Gatineau, for example, the vacancy rate was 0.8% in 2022 and only 8% of available units were considered affordable. In this context, mobilizing private landlords to welcome people who are experiencing homelessness or at imminent risk of becoming homeless is particularly difficult.
  Accurately estimating accommodation and housing needs is difficult. In addition, access to the continuum of care and services remains difficult for people who are experiencing homelessness, especially some particular and specialized care and services
• the multifaceted homelessness crisis: national data collection (enumeration and count exercises) report a real homelessness crisis. For the enumeration of sheltered homelessness, new data has been available since 2024. On April 23, 2024, 9,307 people experiencing homelessness were sheltered, including 5,324 in emergency shelters and transitional housing. The figure is up 15%, that is, 1,228 people more than in 2022. Thus, there has been an increase in sheltered homelessness in Québec since 2018. The average annual increase was 8% between fiscal years 2018 and 2022; it was 10% between fiscal years 2022 and 2024

For the count of people experiencing visible homelessness, the 2022 fiscal year report estimates the number of people who were in this situation on October 11, 2022 at 10,000, including 1,335 in unsheltered locations. This estimate represents a 44% increase in visible homelessness compared with fiscal year 2018. This increase can be seen in all regions that participated in both exercises. The estimated number of people experiencing visible homelessness represents 120 per 100,000 inhabitants, a rate slightly lower than Ontario, but six times higher than that of Finland.

The shortage of affordable housing and the consequences of COVID-19 are among the factors that account for the increase. Moreover, eviction is noted in the 2022 report as the main reason for loss of housing. In 2018, it was substance use disorders.

Examples of homelessness actions

The most recent review of PAII achievements shows that:

• in November 2025, 219 young people and 798 people experiencing homelessness were housed under the Rent Supplement Program (RSP) and were receiving assistance
• in November 2024, 203 people represented by the Curateur public du Québec (including 63 young people) at risk of homelessness saw their situation stabilize
• 222 emergency shelter and transitional housing resources (including 33 dedicated to women and 6 to First Nations and Inuit) received funding to strengthen their service offers
• 36 agreements were concluded with resources to offer accommodation to people experiencing homelessness who are facing issues with substance use
• 81 full‑time resources were added to offer local services to people experiencing homelessness
• 61 full‑time resources were added to support the continuum of addiction services for people experiencing homelessness
• the 2022 enumeration report (in French only), the 2024 enumeration report (in French only) and the Second portrait (commitment of the 2015‑2020 PAII, in French only) were published. a 2025 enumeration report is being drafted
• the Table Québec‑Municipalités en itinérance was created
• a summary of the consultations and analyses (in French only) was published concerning roles and responsibilities, and the Document d’orientation sur les rôles et les responsabilités du gouvernement du Québec à l’égard des personnes en situation d’itinérance ou à risque de le devenir” was completed

Addiction

a large proportion of Quebecers use alcohol or other drugs, gamble and use the Internet daily. Although these activities generally have few or no consequences, for many people, they can carry risks and not only affect them, but also their loved ones, their living environment and society as a whole. Despite the significant progress made in Québec to prevent, reduce and treat the consequences associated with psychoactive substance use and gambling, and despite the solid scientific basis and innovative capacities demonstrated by Québec over the past 30 years, various findings support the development of new government directions.

The global context of psychoactive substance use has, in recent years, been characterized by the emergence of new, often more toxic, drugs and by increased opioid use, whether or not for therapeutic purposes.

The number of opioid‑related deaths has continued to rise in Québec. According to the most recent data from the Institut national de santé publique (in French only), in 2024, 645 deaths were related to suspected opioid or other drug intoxication, a hundred more than in 2022 and 2023. The INSPQ has also already reported more than 150 deaths between January and March 2025. For the week of November 23 to 29, 2025 (latest data available), the number of deaths caused by suspected drug or opioid intoxication was 13, which is higher than the average of the last 26 weeks (11 deaths/week). Finally, the annual rate per 100,000 Quebecers for deaths related to suspected opioid or other drug intoxication increased from 5.1 in 2018 to 7.3 in 2024.

Furthermore, in Québec, the severity of the problem of addiction needs to be better understood and recognized. a significant proportion of people affected have a severe profile that requires as much care as other serious diseases. To illustrate this issue, it is relevant to point out that the World Health Organization has developed a system to rate the disability weight for different diseases. Weights are measured on a scale from 0 to 1, where a value of 1 represents diseases that directly cause death, so the most severe disability. For example, the value for metastatic cancer is 0.48, severe Parkinson’s is assigned a value of 0.55, while amputation of both legs is assigned a value of 0.49. By way of comparison, severe alcohol use disorder is assigned a value of 0.55, gambling disorder, a value of 0.44, and opioid addiction, a value of 0.64. Thus, according to the WHO, the burden of addiction in people’s lives is equal to that of conditions our health system considers to be extremely serious (metastatic cancer, severe Parkinson’s, etc.).

In addition, constant advances in information and communications technologies, the multiple possibilities offered by the Internet and the development of knowledge related, in particular, to the potential effects of its use for some people justify the relevance of broadening the conceptualization of the phenomenon of addiction. In Québec, significant progress has been made in recent years in order to better understand this reality. In the development of evidence‑based clinical practices, a first standardized clinical Internet addiction rehabilitation program for people aged 12 to 25 has been created: the Virtu‑a program. It is a major step forward. However, significant efforts still need to be made to develop a range of services covering the entire continuum, including the development of a clinical program for early intervention in Internet addiction.

These realities are part of the context where access to addiction services, including medical addiction services for vulnerable people, still poses significant challenges. In the first place, a small proportion of people who have addiction problems seek help. When they do, it is often late, that is, several years after the problem has emerged. In addition, the process to access addiction services is often hampered by individual and systemic barriers.

People with addiction problems are more affected by certain barriers, including:

• too few activities to detect and identify addiction problems
• eligibility criteria for certain programs that tend to exclude the most vulnerable subgroups, thus putting pressure on emergency systems such as hospital emergency departments and police services (e.g., exclusion of highly vulnerable people from health clinics)
• medical billing and associated vulnerability codes that do not promote management
• regional medical workforce plans and specific medical activities that do not take addiction needs into account
• the challenges of coordination between different levels of care and between service providers
• silo work, in particular with regard to primary care, mental health and addiction services

These barriers can be explained, among other things, by the fact that the stigma of addiction problems is still very high both among the general public and in the various systems (health, education, work, etc.). The people concerned then face more barriers to accessing services tailored to their needs. And when they face multiple stigmas (women, mental health issues, belonging to an Indigenous or ethnocultural community, sexual and gender diversity, etc.), these difficulties are exacerbated. So access to primary care medical services is particularly difficult for these populations.

In short, people who use psychoactive substances or who are struggling with one or more addictions are still among the people most affected by social inequalities in health today, even though they are among the groups with the greatest health and social services needs.

However, the statistical data on services show a significant increase in the need for addiction services. Thus, in 2025:

• 28,175 users received early intervention addiction services through the local community services centres (CLSCs) mission. This represents an increase of 22.6% compared with 2019
• 49,154 users received specialized addiction services through the addiction rehabilitation centre mission of health and social services institutions. This represents an increase of 8% compared with 2019
• 1,234 users with an Internet addiction disorder received specialized addiction services. This represents an increase of 280% compared with 2019
• 2,335 users were waiting to receive specialized addiction services for the first time. This represents an increase of 43% compared with 2019
• the average wait time to receive specialized addiction services for the first time was 33 days. This represents an increase of 55% compared with 2019

Examples of addiction actions

• Annual campaigns comprising four components: Addiction Prevention Week: cannabis, alcohol and psychoactive substance overdose component
• Monitoring: overdose monitoring data is published on the INSPQ website and updated quarterly
• Implementation of the PAUSE campaign, with many tools available continuously
• Implementation of psychoactive substance testing services at festivals and community events (mobile units) in six regions of Québec
• Implementation of a continuous training course in responsible gambling among active Loto‑Québec employees
• Deployment of 13 supervised substance use services in six regions of Québec
• Primacy of public health and safety principles in overseeing the sale and advertising of cannabis
• Improvement of programs that offer alternatives to judicialization, such as the “Programme d’accompagnement justice et santé mentale (PAJ‑SM)”, which has been adapted to better reflect the situation of people with a substance use disorder, gambling disorder or Internet addiction
• Consolidation of intensive outpatient services for young people
• Development of successful clinical programs for young people and their families, such as Virtu‑A, Cap sur la famille, IP Jeunes and TAPAJ
• Development of the Mes Choix program; it now covers the use of cannabis and other substances, like the one for gambling
• Deployment of the “Programme de soutien à la pratique médicale de première ligne en dépendance et en itinérance”
• Implementation of various clinical and organizational support structures: the Centre d’expertise et de collaboration en troubles concomitants (CECTC); the Équipe de soutien clinique et organisationnel en dépendance et en itinérance (ESCODI); the Communauté de pratique médicale en dépendance (CPMD)
• Development of the Sage usage program (early intervention program tailored to the realities and needs of Indigenous populations)
• Work to update training included in the “Programme national de formation en dépendance” (PNFD)

References

1. Ministère de la Santé et Services sociaux (2022). S’unir pour un mieux-être collectif : Plan d’action interministériel en santé mentale 2022‑2026 (in French only)

2. Government of Canada (2025). Homelessness data snapshot: Mental health, substance use, and homelessness in Canada, Housing, Infrastructure and Communities Canada – Homelessness data snapshot: Mental health, substance use, and homelessness in Canada

3. Ibid

4. Ministère de la Santé et des Services sociaux (2022). S’unir pour un mieux-être collectif: Plan d’action interministériel en santé mentale, p. 3

5. See the interministerial action plans on mental health, homelessness and addiction

6. Ministère de la Santé et des Services sociaux. Cadre de référence pour l’organisation des services en déficience physique, déficience intellectuelle et trouble du spectre de l’autisme, Vers une meilleure intégration des soins et des services pour les personnes ayant une déficience, pp. 32 and 35

7. World Health Organization. Constitution of the World Health Organization, Official Records of the World Health Organization, No. 2, p. 100, entered into force on April 7, 1948

8. Ministère de la Santé et des Services sociaux. Plan d’action interministériel en santé mentale, S’unir pour un mieux-être collectif, 2022, p. 3

9. Ibid

10. Canadian Mental Health Association. Fast Facts about Mental Health (online), https://cmha.ca/brochure/fast‑facts‑about‑mental‑illness/ (accessed December 23, 2025)

11. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID‑19: a Meta‑analysis | Adolescent Medicine | Jama Pediatrics | Jama Network

12. Institut national d’excellence en santé et en services sociaux. COVID‑19 : regard sur la fréquentation des urgences par les adolescents pour certaines problématiques de santé mentale et psychosociales (in French only)

13. Institut national de santé publique du Québec. Surveillance du trouble du déficit de l’attention avec ou sans hyperactivité (TDAH) au Québec en contexte de pandémie de la COVID‑19 (in French only)

14. Canadian Mental Health Association Quebec Division. The state of mental health in Canada? It’s alarming, a new Canadian Mental Health Association report finds

15. Mental disorders and access to mental health care

16. Mental Health Research Canada. The Impact of Economic and Political Strain on Canadians’ Mental Health

17. All but the last of these data come from the PAISM, p. 4.

18. Institut national de santé publique du Québec. Troubles anxio‑dépressifs (in French only)