Mental health policy and practice across Europe: an overview

The evidence base 115
sources of evidence, each using their own methodologies with all their attendant
strengths and weakness? How can we ensure that people have a better understanding
of the fact that a lack of evidence on the effectiveness of an intervention
does not equate with evidence of a lack of effect? Perhaps most critically,
how can policy-makers and their advisers more easily identify badly-conducted,
poor-quality studies that otherwise erroneously may have an impact on policy
and practice and deny scarce resources to other more effective activities?
Approaches to improving capacity within the policy community in order to
interpret and make use of information will be discussed further below.
Meeting the challenge of knowledge transfer
It is important to recognize that knowledge transfer is complex: decision-making
is never a simple linear process where information from knowledge producers
and others informs the policy-making process. Rather, there are many competing
factors and influences that must be taken into account; for instance, political
considerations, industry, service and family group advocacy, as well as ethical
and equity concerns. Public inquiries, which sometimes take place over many
years, may also be a driver of policy. A series of public inquiries into mental
health in New Zealand have been closely linked to the development of mental
health policy in that country (Brunton 2005). Policy-making might also be
influenced (for better or worse) by the personal experience of policy-makers of
mental health problems in their own families, as well as by scandals or events
reported in the media. For instance, it was one television documentary about
conditions at an asylum on the island of Leros in Greece in the early 1980s
rather than any scientific evidence that provided the impetus for mental health
system reform (Strutti and Rauber 1994).
With the relatively rare example of the Leros situation and other scandals
and sensational events, in most instances it can take much time for evidence
to inform the policy-making process – decisions are unlikely to be made in
response to one piece of information (a knowledge-driven approach). The many
models of research utilization (Hanney et al. 2003) also include various political
and problem-solving models all the way through to suggesting that information
may have a pervasive ‘enlightening’ impact over time, helping to build
awareness and to promote the future acceptability of pieces of knowledge
(Weiss 1979).
It should also be remembered that measuring the impact of evidence in the
policy-making process can itself be an extremely complex and difficult task,
requiring a high degree of access to the decision-making process in order to
truly identify connections between evidence and policy. It is especially difficult
when, as a result of new evidence, the status quo is maintained, so on the
surface, at least, nothing appears to have changed. Furthermore, even when an
apparent link can be observed between the publication of a specific report and
changes in policy and practice, such information in fact may simply be used as a
justification for a preordained action or something that policy-makers already
believe in (Weiss 1999).
Nevertheless, if we are to improve the facilitation of knowledge transfer in the
policy-making process it is helpful to understand some of the practical barriers