Welfare Reform on the Web (June 2009): Mental health services - overseas

Managerial audit and community mental health: a study of rationalising practices in Finnish psychiatric outpatient clinics

S. Saario and P. Stepney

European Journal of Social Work, vol. 12, 2009, p. 41-56

In many European welfare states the reform of mental health services has been accompanied by the implementation of new and more extensive forms of governance, including the introduction of effective audit systems. Such systems have typically been developed to provide a means for quality assurance, financial management and the monitoring of staff performance, but may have unintended consequences. This article examines the role of a particular audit system in community psychiatric care in Finland and assesses its impact on practitioners. It demonstrates that, although the audit system primarily served administrative purposes, it began to reshape practice by reinforcing certain modes of working and excluding others.

Mental health, resilience and inequalities

L. Friedli

Copenhagen: WHO, 2009

This report reviews evidence on what makes people resilient and enables individuals and communities to flourish in the face of adversity. It reviews international evidence on the relative importance of psycho-social factors, material factors such as income, housing and employment, and the gap between rich and poor. The research shows clearly that the prevalence of mental ill health and other social problems rises as income inequality increases in societies. As mental ill health is socially determined, policies and programmes that support the improved mental well-being of the entire population are vital. There is a need to:

• Create social, cultural and economic conditions that support family and community life
• Provide education that helps children to flourish emotionally as well as economically
• Offer employment opportunities and workplace pay and conditions that promote and protect mental health.
• Encourage partnerships between health and other sectors to address social and economic problems that cause mental distress.

(For summary and comment see Mental Health Today, May 2009, p.10-13)

Psychiatry reimbursement in Sweden: models and experiences

B.C. Forsberg, K. Westling and M. Knezevic

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 117-124

Swedish health services are funded by county councils with minimal input from central government. This article traces the development of performance-based reimbursement models for psychiatric services by Stockholm, Skane and Vastra Gotaland. Performance-based reimbursement of providers was intended to improve the quality and accessibility of care, reduce costs, and promote outpatient services. All three councils introduced contracts with providers based on a mix of fixed reimbursement, performance-based reimbursement, and quality-based incentive payments for delivered patient care.