Early Implementation of Collaborative Care in France: Facilitators and Barriers from the First Year of the SESAME Program.

Abstract

Background The Collaborative Care Model (CoCM), which integrates mental health services into primary care through a team-based approach involving GPs, care managers (CM), and mental health consultants, is a proven way to meet these challenges. A first CoCM adaptation in French primary care settings called SESAME has been implemented since 2021. Methods Semi-structured interviews were conducted with all the healthcare professionals involved in SESAME to examine the facilitators and barriers experienced during the first year. Data were analyzed using a qualitative approach combining manual thematic analysis and lexicometric analysis with ALCESTE software. Results Four discourse classes emerged from the analysis. Key facilitators included prior collaborative experience, effective digital communication tools, and clear role understanding. Barriers such as technological challenges, role ambiguity, and referral framework misunderstandings were also identified. The structured inclusion process and rapid access to care were appreciated, but challenges persisted in referral processes and role boundary definitions. Financial coverage and a less stigmatizing approach were seen as benefits. Conclusion This study provides insights into the early implementation dynamics of CoCM in a novel context, underscoring the need for clear protocols, ongoing communication, and tailored support to ensure successful integration of mental health services into primary care.