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

Competing institutional demands: a framework for understanding mental health policy

T.L. Scheid

Social Theory and Health, vol. 6, 2008, p. 291-308

This paper draws from institutional theory to provide a framework for understanding mental health policy, focusing on the cases of North Carolina and Wisconsin. Institutional theory directs attention to the environment surrounding mental healthcare delivery systems, and argues that the systems respond to both technical and normative demands operating within the external environment. However, these demands are often contradictory and ambiguous. Consequently, mental health policy lacks coherence and consistency, and delivery systems come to reflect the interests of the most powerful institutional actors within a given system. Mental health services currently seek to incorporate two opposing ideological models of care: the commodity model and the community model. The commodity model is a reflection of technical demands for efficiency, outcome assessment and cost containment. The community model is a reflection of normative demands for effective services, quality care and access to care. The challenge for organisations is to balance these conflicting institutional demands.

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