Mental health policy and practice across Europe: an overview

114 Mental health policy and practice
characteristics of their school, and outcomes for patients by the characteristics
of the specialist or primary care clinical service they attend. We are not aware of
formal guidance on the use of such methodologies in relation to implementing
governmental or administrative policies. However, an excellent guide to multilevel
methodologies used in the evaluation of health care systems has been
published by Health Technology Assessment (Ukoumunne et al. 1999). This
guide covers formal randomized experimental evaluations as well as the design
and interpretation of naturally-occurring phenomena.
Invest in the development of knowledge transfer mechanisms
between policy-makers and other stakeholders
We began this chapter by noting that too often evidence has little impact on
policy-making, or such evidence is lost within the myriad of different political
and public demands, anecdotes, myths and lobbying that policy-makers have
to contend with. Three specific types of questions are likely to arise from policymakers
(Lomas 2005). In addition to the question familiar to those looking at
issues in EBM as to whether something works (with greater emphasis on setting
and context), policy-makers are also likely to simply want to know whether an
issue is something significant that merits attention. If it is significant, what is
causing this, how extensive is it, who is it affecting and what are some possible
options for addressing it? A third question relates to the consequences of undertaking
a specific action. This is, again, a context question to help inform the
stakeholder – issues may include identifying those interest groups who support
or oppose the action and why, as well as looking at who will be affected, with
what consequences and what possible side-effects. It may also consider what
other actions should be taken alongside the planned action or reform.
Formulating and implementing mental health policy is thus heavily dependent
on political support and building partnerships and coalitions between different
stakeholder groups. One key issue is how to improve the linkages and
opportunities for exchange of information between those individuals generating
evidence and those who wish to make use of evidence. This objective should
consider how to ensure that evidence from all perspectives, including those of
service users and families, has an opportunity to inform the policy-making process.
Structures and mechanisms for user involvement have been particularly
weak across most of Europe. In some of the countries of central and eastern
Europe, the challenge is even greater still as there has been little culture of
community involvement in policy-making with no history of users and families
forming themselves into non-governmental bodies to put forward a case for
greater attention to mental health. Later in this section we will look at an
example of an approach to foster such local participation in the policy-making
process.
The context in which evidence is used is crucial; there may be a limited institutional
and individual capacity to interpret and make use of evidence alongside
other information sources (Lomas 2000; Oliver and McDaid 2002; Lavis et al.
2003). How can we further develop the capacity within the policy-making
community (and indeed among other stakeholders) to interpret the different