Mental health policy and practice across Europe: an overview

116 Mental health policy and practice
that have to be overcome. These can include the absence of personal contact
between those generating evidence and the policy-making community. It may
also be the case that evidence does not provide answers to the key policy questions
of interest to decision-makers. Reports may be incomprehensible and
a lack of transparency in how results are reported may make comparisons
between studies with conflicting results difficult.
The environment in which policy development, legislation and implementation
operates also needs to be fully understood. This policy environment
includes the structures in ministries of health, the dynamics and tensions
between ministers, civil servants, professional advisers within government, professional
advisers outside government, the influence of users and carers, the
influence of the media and of the general public, and the influence of related
professionals (e.g. lawyers specializing in mental health legislation). There can
be a gulf of understanding between these different groups, who effectively speak
different languages, have different conceptual frameworks for their understanding
of mental health issues, and have differing degrees of access to the available
information. Frequent staff moves and organizational changes compound the
difficulty of developing a shared understanding and shared goals and strategies.
Frequent personnel moves, especially of ministers, means that there is an
inevitable discrepancy between the timescales allowed for policy development
and the timescales for research evaluation, so that policy development nearly
always runs faster than research timetables.
Building links between stakeholders
Good personal links between researchers and policy-makers allow for an iterative
process of dialogue and an exchange of views to take place. Bringing both
groups together at an early stage, along with other key stakeholders, in order to
identify research questions, which are both of policy relevance and feasible
from the point of view of research, has been shown to be effective. Partnerships
set up between groups for the purpose of developing and implementing policy
can be more effective both in producing research and in its effective dissemination
(Walter et al. 2003, 2005). A supportive environment can also help in the
uptake of research. Such a partnership model has been created with some success
in linking a university-based research unit with the mental health policy
branch of the Ontario provincial government (Goering et al. 2003).
Promoting user involvement in the policy-making process:
the example of the Pathways to Policy project
There is increasing recognition that users, families and other grass-roots stakeholders,
including informal and formal carers, professionals and managers, historically
have been excluded from the existing policy process. Advocacy within
the policy-making community by these groups can help promote improved
quality and better appropriateness of services; therefore, mechanisms to promote
the opportunity for advocacy need to be fostered (Funk et al. 2005).
Examples of how to tackle this objective include the establishment of local and
national policy forums which can now be found in several countries in western