Encephale
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Treatment of severe mental illness in the community is gaining interest under ethical, clinical and economical pressure, which has led to mental health reform and deinstitutionalisation. However, this can lead to conflicts between all the parties involved in the community. Several countries have initiated extensive efforts to coordinate health services to enhance quality of care without increasing costs. According to Gray [Hum Relat 38 (1985) 911-936.], the first conditions facilitating interorganizational collaboration are the identification of common problems, recognition of partners (legitimacy and expertise) and interest in collaborating gains to be made from such collaboration [int J Health Plann Manage 17(4) (2002) 315-32.]. ⋯ Deinstitutionalisation and more respect of patients' rights were considered as positive changes for most patients, but as a risk for the most vulnerable ones. Clearer mental health policy targets were requested for suicidal, difficult to engage and dual diagnosis patients. Collaborative efforts must focus on teaching primary care professionals for suicide and dual diagnosis patients, on direct help to welfare services for difficult to engage patients and on psychiatric services for high users. Intensive home care and liaison with primary care are viewed as key components. Identifying common targets in the network may enhance collaboration. Pathways to care need to be studied, including people involved outside a "classical" health network, such as police, welfare services and patients or carers associations.