Transformation of a mental health system – the case of Scotland and its lessons for Australia
The ability of health systems to successfully transform has become a concern for both policy makers and academic researchers over the past five years. This working paper, based on over 50 interviews, observation and extensive document analysis undertaken over a four year period, reviews the transformation of Scottish mental health policy over the past ten years in order to examine processes which led to transformation. In reviewing the Scottish case we find that between 1999 and 2009 the Scottish mental health policy and legislative frameworks for mental health were completely transformed. The main factors contributing to the initial transformation were:
- devolution of the Scottish Parliament which acted as a moment of policy crisis,
- widespread perception of the problematic nature of the current legislative and policy framework,
- publication of dramatic statistics on suicide in Scotland which led to attention in the media and within parliament,
a focus on openness and consultation,
- high levels of communication within the sector.
Ongoing sustained transformation and innovation within mental health policy in Scotland fostered by:
- ongoing consultation, meetings and other ‘talking events’,
- the establishment of networks for fostering communication within key areas of the system,
- creation of effective routes for the spread of innovation,
- acceptance of policy failure,
- development of a decentralised system where central control is maintained through the use of targets and indicators,
- external validation of the Scottish mental health system through involvement with international actors such as WHO,
- development of an identity for Scottish mental health policy – ‘the Scottish way’ – which motivates action.
The Scottish case provides opportunities for policy learning. Many of the processes and events which took place in Scotland can be adapted to Australian circumstances. Here the paper highlights specifically:
- the exploitation of natural ‘moments of crisis’ for their potential to act as catalysts for transformation,
- the necessity for exploring and developing existing and new channels for organisation and communication,
- the publication of stories and statistics which highlight the need for change and the strategic utilisation of the media in this,
- transformation of the bureaucracy to facilitate communication and to allow new ideas to enter policy.
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