Mental health policy and practice across Europe: an overview

416 Mental health policy and practice
Demands on mental health policy in the region
Being defensive because of anxiety provoked by nascent change is part of human
nature. Finding a way around it is a serious challenge for mental health policymakers,
particularly as the solution should respect the rights of individuals to be
true to their nature. Good governance in mental health is exactly about this and
is not readily available in times of transition, times that place huge demands on
leadership (Tomov et al. 2003). To get an idea of such demands one needs to
consider that at times of transition mental health policy should at least:
• provide for the expected new needs within the general population precipitated
by the stress of transition, which may manifest themselves as an
epidemic of common mental illnesses;
• plan additional services for major psychiatric disorders in anticipation of the
fact that the turmoil of change will aggravate their clinical severity and
course;
• proceed with the restructuring of general psychiatric services, to re-orient
them towards community-based care in line with the demands of the political
agenda;
• respond to the rising demands for specialist psychiatric service – child and
adolescent, geriatric, forensic, substance abuse – demands that erupt when
the lid of central control is lifted off a community.
But first, and above all, mental health policy during times of transition should
take good care of the country’s mental health system itself – the single most
important tool needed to deliver all of the measures listed above. However, the
system can also be a tool that employees predictably will use as a social defence
against their own anxiety about change, rendering it a much less pliable health
instrument than it is normally. This becomes the case particularly when a country’s
political agenda prescribes reform of the health system itself. It should be
clear by now that reform policy is linked with the social power implicit in positions
and roles, or rather with their loss, or the threat of loss. Such things are
painful and many people will go to great lengths to avoid or postpone them. In
this they follow identifiable patterns, including:
• Reframing is a strategy of resistance to change that boils down to stripping the
proponents of reform of all positive human qualities, ascribing these to oneself,
while assigning to reformers all the negatives, including those introduced
to the situation by oneself. It is a particularly vicious way of going ad
hominem.
• Obstructing entrepreneurship. At times of transition, entrepreneurship manifests
itself as the capacity to act within the real world constructively and with
an awareness of the risks involved. An example would be to ask consumers
what they want and eventually integrate it into the service profile. The barriers
to achieving this in the countries of the region are formidable and are
rooted in the quagmire of centralized bureaucracy.
• ‘Rubber fence’ responses are an organizational defence whereby no new development
provokes curiosity but is played down by claims that it is already part
of routine activities.