Summary on Territorial Health Schemes: Strengthening the Involvement of Addiction Services in Territorial Health Schemes

🔍💡 Territorial health arrangements: this brief shows how to integrate addiction care into CLS, CPTS, PTSM, CLSM and CLSPD to effectively act on care pathways and health inequalities.
🔍💡 Addictions and local areas: very concrete barriers, operational levers and field examples to gain influence in local health and safety bodies.
#Addictologie #SantéTerritoriale #pratiquesensante

Source :     📒 Synthèse sur les dispositifs territoriaux de santé : renforcer l’implication des structures d’addictologie dans les dispositifs territoriaux de santé 📜🔗LIEN 

Analytical summary

Context and challenges: multiple schemes, limited involvement

The brief describes the rise of territorialisation in health policies since the 1990s, with a multiplication of consultation mechanisms (CLS, CPTS, PTSM, CLSM, CLSPD, ASV, MSP) that structure access to care, prevention and mental health at local level. It shows that these forums offer major opportunities to coordinate care pathways and reduce inequalities, but they remain difficult to read and sometimes hard to access for addiction services, which are under‑represented in them. The document identifies structural barriers (complexity, fragmentation, insecure funding), relational barriers (stigma, power imbalances) and organisational barriers (lack of time, support and training), which limit the engagement of addiction teams. It is set in a context where mental health has been declared a Great National Cause for 2025, which reinforces the need to connect mental health and addictions within territorial schemes. The brief positions itself as a complement to the “Boîte à outils des dispositifs territoriaux en santé”, focusing on barriers, levers and field experience rather than on a simple mapping.

Operational contributions: clarifying, equipping and strengthening local alliances

The document offers a structured presentation of the main territorial schemes (CLS, CPTS, CLSM, PTSM, CLSPD, ASV, MSP, etc.), specifying their sponsors, scope, potential roles for addiction services and concrete ways addiction structures can get involved. It provides a detailed analysis of the barriers faced by addiction actors and identifies levers for action: making schemes easier to understand, increasing the visibility of services, developing orientation tools and building a shared culture through joint training. The brief draws on feedback from practice (Loiréadd, MAS Lyon, CEID Bordeaux, AEP Hauts‑de‑France, CLSM in Occitanie, ESI 14 in Lisieux) to illustrate concrete configurations of co‑construction and intersectoral work. It formulates operational recommendations for addiction services and their partners: active participation in local bodies, appointment of focal points, alignment with a “Health in All Policies” approach, mobilisation of sustainable funding and use of national resources such as the toolbox.

Key points of the document

Clarification of the main territorial schemes and their role in addiction care (CLS, CPTS, CLSM, PTSM, CLSPD, ASV, MSP), with a detailed glossary specifying sponsors, scope and ways addiction services can get involved (pp. 5–7, 20–23).

Structured identification of barriers to the engagement of addiction actors: lack of clarity, low visibility, fragmentation, stigma, unfavourable power relations, and constraints on human and financial resources (pp. 8–9, 14–16).

Highlighting concrete examples of local collaboration: Loiréadd and the CLS in Roanne, MAS and the CLSPD in Lyon, CEID and the CLSPD in Bordeaux, AEP and the PTSM, a CPTS in Hauts‑de‑France, CLSM in Occitanie, ESI 14 in Lisieux, with descriptions of actions, impacts and success factors (pp. 10–13, 18–19).

Operational recommendations to strengthen the participation of addiction services: improving the readability of schemes, developing tools (directories, maps), organising inter‑professional meetings and targeted training, and structuring focal points and intersectoral dynamics (pp. 14–16).

Integration of addiction issues into a “Health in All Policies” approach, underlining the need for multi‑year funding, the explicit inclusion of addictions among CLS/CPTS/CLSM priorities, and coordination with safety and urban planning policies (pp. 16–17, 20–21).

Actionable pathways for local actors

Use the glossary and the toolbox to map all schemes in the territory (CLS, CPTS, CLSM, PTSM, CLSPD, ASV, MSP) and identify, for each body, possible entry points for addiction services (contact, participation in working groups, project proposals) (pp. 5–7, 20–23; online toolbox).

Use the examples of Loiréadd, MAS Lyon, CEID Bordeaux, AEP, CLSM in Occitanie and ESI 14 as project templates to build, with elected officials, law enforcement, PTSM or CLSM, actions that combine prevention, harm reduction, social mediation and mental health (pp. 10–13, 18–19).

Set up one or more “territorial schemes” focal points within addiction services to monitor CLS/CPTS/CLSM/PTSM/CLSPD, ensure representation of the service and share opportunities internally (training, calls for projects, working groups) (pp. 14–16).
Co‑organise, with ARS, local authorities, CLSM, CLS or CPTS, awareness sessions and joint training on addictions, mental health, harm reduction and anti‑stigma work, based on identified needs and national resources (HAS, Fédération Addiction, CAPS, OSCARS) (pp. 9, 14–16, 20–21).

Negotiate the explicit inclusion of addictions among the priorities of CLS, PTSM and CLSM, and work with ARS and local authorities on multi‑year funding aligned with regional programmes (PRS, PRLT), to secure actions and avoid exclusive dependence on short‑term calls for projects (pp. 8–9, 16–17).