During the course of a regional symposium on mental health that took place at Sept-îles in October 1986, the author presented his views concerning the organization of mental health services in the North Shore region. In this article, he develops the two central ideas that supported his presentation. Firstly, he attempts to show to what extent it is imperative to deal with the issues surrounding alternatives to institutionalization; secondly, he attempts to show the importance of operationalizing services offered in small communities, in the area of preventive mental health care.