MENTAL HEALTH POLICY



Mental Health Policy

Mental Health Policy

Introduction

The purpose of this paper is to review doctoral research findings that explored how policy making has worked in mental health services in the UK over the last 20 years. Over the last century, the key mental health policy that has unfolded is that of “care in the community” and it is this policy, what foreshadowed it and what followed it that was the focus of the study. Mental health policy, like much public policy, does not have a clear beginning, middle or end. To focus exclusively on policy formulation or implementation would preclude any analysis of the relationship between and beyond these stages. It would also cause difficulties when attempting to look at outcomes and how they are affected by early policy activity. So the research attempted to tell the whole story, though not always in chronological order (Conn, 2007, 2-58-258).

Taking into account the personalities and people who shaped mental health policies throughout the recent history of mental health services enriched understanding of individual actions, and provided an interesting and identifiable foreground of characters to the story. Rather than examining policy through concepts solely drawn from academic theories and interpretation, the intention was to draw on the experiences and perceptions of the politicians, managers and professionals involved in the decision-making process. This did not give a complete picture - but what people tell us helps us to understand their beliefs, culture and values as well as forming a comparison between what different people think happened and official documentary narration. There was also a backdrop to this story that was composed of more global forces, relationships and structures of mental health policy in the UK.

Policy-making themes and perspectives

These initial findings raised further questions of course, and in order to look systematically and in more detail at how policy unfolded, key themes were selected that seemed to lie at the heart of policy making in the UK (Ballard, et al 2001, 93-106). A number of writers had researched into the impact of single themes, but it was clear that examining these themes individually and as interacting components would yield much richer results. These themes included:

power relationships and the structures which facilitate and constrain them;

knowledge and advice in the decision-making process;

language and culture in the organisation;

rationality and other approaches to formulating policy;

the impact of people on the organisation, and the organisation on people;

the use of discretion in the policy process;

linking stages of policy;

difficulties in implementing policy.

The themes were not exhaustive, or even mutually exclusive. But they showed different aspects to mental health policy, which complemented each other, and assisted in telling the “whole story”. These themes cropped up in various stages of the policy-making process, sometimes more than once, and were tackled when they occurred, as policy unfolded. They provided the basis for an exploration of how mental health policy making in the UK has unfolded over the last 30 years and the reasons behind the implementation (or lack of implementation) of different policy measures ...