Mental health policy and practice across Europe: an overview

Policy in former eastern bloc countries 417
• ‘Privatization’ is a maladaptive way of acquiring ownership over work tasks by
replacing, in a subtle and unacknowledged way, the primary task of an organization
(e.g. care for people with mental health problems) with a private task
(e.g. attending to staff anxieties provoked by transition).
• Anonymity is a denial of the need to acknowledge the patient as an individual
in order to build the trust upon which to base interventions. It exposes the
thwarted capacity of staff to enter into personal relationships with patients
and with each other.
This list of maladaptive patterns that plague the organizational culture of
health services, and that governance structures have to take into consideration,
can be extended (Geneva Initiative on Psychiatry 2000). The more pertinent
issue, however, is what action can be taken regarding the aspects of human
nature that threaten failure for health systems. Are there limits where governance
can afford to play down the importance of attending to tasks with the
genuine excuse that the well-being of the organization should not be jeopardized?
Such limits certainly exist but they cannot be set in the culture of the
region as the example of political psychiatry clearly attests. The reason why this
is the case is pretty much the same now as it was then. It is the fact that the
answers to questions of governance strategy are traditionally addressed behind
the scenes and out of public view, which is exactly the setting that favours
defensive-mode solutions, solutions which disavow large portions of reality.
Participatory action research
Cultures of non-participation can embark on the road of mental health reform
if defensive responses to change are repeatedly challenged in open debates until
behind-the-scene decision-making is banned. Complicated as this approach may
seem, it is well established in developed democracies and much discussed in the
literature on leadership and management in the area of action research. There
are many attempts to make it intelligible for actors in all domains facing the
challenges of innovating human systems. When devising the method, K. Lewin
(in 1946) reportedly meant ‘. . . research that would solve practical problems
and contribute to general scientific theory’ (Elden and Chisholm 1993).
Introducing the practice of deliberating on mental health policy while it is
being made, rather than just imposing it, is indeed a practical problem of huge
social significance, not only within this region. Thus, in 1985 Korman and
Glennerster wrote: ‘the reason why some policies are not implemented is that
no one ever expected them to be. Acts are passed or ministerial speeches made
to satisfy some party pressure or some awkward interest group, but civil servants
know that they need not strain themselves too hard to achieve results. The
policy is symbolic’. The specific policy Korman and Glennerster were referring
to was the closure of a psychiatric hospital in the United Kingdom. The community
mental health policies developed by health administrations in many
countries in eastern and central Europe are regarded by influential corporate
groups precisely as documents that are not meant to be implemented. Gill Walt
(1994), who quotes Korman and Glennerster in her book on health policy,