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Welfare Reform on the Web (January 2008): Mental health services - overseas

The emerging mental health strategy of the European Union: a multi-level work in progress

B.D. Kelly

Health Policy, vol. 85, 2008, p. 60-70

In 2005 the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper and launched a consultation process aimed at mental health service users, advocates, providers, business and social services, and governments. While there were varying levels of participation between member states, a range of trans-national, national and infra-national actors made contributions. Based on these consultations, a 'Consultative Platform' was created and made ten recommendations centred on the principles of partnership, establishing policy competencies, integrating mental health into national policies, involving stakeholders and protecting human rights. This process illustrates many features of EU policymaking:

  • the European Commission generates an initiative
  • policy focuses on EU standardisation, with member states remaining responsible for service delivery
  • policy focuses on social inclusion
  • the European Commission coordinates diverse networks of actors
  • there is 'multi-level' involvement, with direct interaction between trans-national, national and infra-national actors.

Mental health service delivery in Ontario: how do policy legacies shape prospects for reform?

G. Mulvale, J. Abelson and P. Goering

Health Economics, Policy and Law, vol. 2, 2007, p. 363-389

The history of mental health policy in Ontario has been marked by frustrated attempts to move from hospital treatment of mental illness to a system where more emphasis is placed on community-based care. This article examines how the legacies of two prior policies - (1) the introduction of provincial psychiatric hospitals (then asylums) in the 1850s, and (2) the introduction of health insurance (medicare) into the province in the late 1950s and 1960s - have influenced repeated efforts to develop a co-ordinated, consumer-centred mental health system and achieve a significant rebalancing of spending from institutional to community-based care. The authors identify four important policy legacies that have impeded reform:

  1. the separation of mental and physical health policymaking in government, and the lower priority given to mental health
  2. the entrenched emphasis placed on hospital- and physician-based mental health care
  3. the strength of physicians in policy-making compared with other mental health providers
  4. the limited public interest in mental health policy.

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