Mental health policy and practice across Europe: an overview

418 Mental health policy and practice
asserts that the policy process works interactively. Indeed, limiting policymaking
to the development of coherent documents is hardly worth the effort
even when such policy is evidence-based, context-relevant and criterionguided.
The interactive nature of the policy process implies that those who
will implement policy would not be empowered to do so unless they have
participated in the decision-making process.
Organizational cultures that impede progress need to import expertise for
innovative change from outside the organization. In the case of the former
eastern bloc countries this can only be achieved through international aid. In
the case of action research such importation always begins with obtaining a
mandate from local administrative structures. A mandate codifies awareness of
the problems and a commitment to searching for solutions by those with whom
the power of decision-making lies. In this sense it represents a promise for
success.
Under the action research paradigm ‘social defence’ entails an intrusion into
the activity of the organization by the interests and motives coming from the
private lives and histories of its members. This intrusion is attributed to anxiety,
related to the task faced by the organization (e.g. mental health policy reform)
and is experienced as a threat (see ‘Privatization’ above).
In order to handle such experiences governance practices informed by action
research would draw a distinction between the technical system (e.g. psychiatric
care and treatment), the social system (e.g. staff, administration, patients) and
the relationship structures that bring the two systems together (e.g. management,
leadership, group life) (Pasmore 1995). Action research argues that
‘because organizations employ whole persons, it is important to pay attention
to human needs beyond those required for the regular performance of tasks
dictated by technology’ (Emery and Trist 1971). Such practices would also
ensure the closer involvement of the participants in observing how their organization
functions and would encourage them to generate findings and interpretations.
In the process they would acquire ownership over the organization,
its tasks and future.
An example of good practice
Experience in coping with the complexity of transition in mental health systems
in the former eastern bloc is being gradually accumulated. Social defence
issues would usually be identified when reformist groups, supported by grants
from international bodies, would attempt to set up services in response to needs
that had been neglected for decades and could be brought into the open due to
political change. The scope of this practice has been growing since the early
1990s. The moment has now come when the monolithic control of the psychiatric
establishment over decisions in mental health policy is being challenged
regularly by activist groups of patients, relatives and professionals. Politicians
have begun to acknowledge the existence of diversity of opinion and conflict of
interests in this area. The new policy documents that most countries have
developed in mental health policy reflect this important development.
A good illustration of how the power and policy scene is changing is a