Thesis (M. Soc. Sc.)--University of Hong Kong, 1986.

Thesis (M.P.A.)--University of Hong Kong, 1991.

Thesis (M.P.A.)--University of Hong Kong, 1991. / Also available in print.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1986. / Also available in print.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Social Sciences

Abstract The global burden of neuropsychiatric disorders is rising worldwide. This burden will be felt most in developing countries which have limited resources to respond. Within the health sector, mental health has traditionally been a low priority in most countries, resources to address the burden are limited and mental illness competes with other serious disease for government attention. Despite high-profile international statements, mental health reform has been slow and mental health has remained a low-level political priority, particularly in developing countries and Newly Independent States. There is growing recognition of the need for mental health development and reform. There is growing consensus that successful delivery of mental health interventions to address the disease burden is constrained not only by resource limitations but also by the absence of policy and planning frameworks to identify and deliver these interventions. This thesis highlights that the preparation and adoption of a policy position and the development of a comprehensive policy document is the outcome of a range of complex interactions between environmental factors and the stakeholders within the policy environment. There is growing recognition within the policy sciences literature that a comprehensive understanding of the overall policy process requires an individual and combined understanding of the content of a policy and the processes involved in achieving policy status and implementing policy. Little is documented regarding the content domains and elements which should be included in a mental health policy and the key variables within the policy environment which impact on the mental health policy development process. As a result there are no universally applicable blue prints or policy formulation tools for mental health policy which recognise the complexity of mental health systems and identify key issues which need to be considered in understanding how to promote mental health onto the policy agenda, how to develop a policy once this has been achieved and how stakeholders can more effectively engage in mental health policy agenda building. This thesis addresses this issue by undertaking three distinct but interlinked tasks. Part 1 contributes new knowledge to the area of mental health policy content. It identifies the key content domains and elements which constitute a comprehensive mental health policy. The domains and elements are validated through an extensive consultative process, undertaken by the author, with key mental health stakeholders in 40 countries in all six WHO regions of the world in 2000 and 2001. Based on this work the thesis develops an innovative conceptual tool for mental health policy makers, The Mental Health Policy Template. Whilst responding most particularly to the needs of developing countries and Independent States, the Template is sufficiently generic to be used in a range of countries, provinces and at district levels. The experience of many mental health reformers in developing countries and Newly Independent States is that raising mental health onto the policy agenda and maintaining it there is an on-going challenge. Conceptual models for understanding mental health policy process are extremely limited. Part 2 of this thesis responds to this situation by drawing on the policy analysis literature, with particular focus on agenda building. It identifies two key variables, Context and Stakeholders and their components. These variables are argued to impact on raising mental health onto the policy agenda. The applicability of these variables and their components is demonstrated through the analysis of two country experiences of mental health policy development and reform. One country, Lithuania is a Newly Independent State and the other, Zambia is a developing country. The information collected for these country studies was developed by a series of country visits and stakeholder consultations by the author between 2000 and 2007. The analysis of the country data suggests that the experiences of two quite disparate countries can be usefully organised using the variables and components identified from the literature and may be applicable across a diverse range of countries. This constitutes new knowledge of the variables which impact on mental health policy process and mental health policy reform. Part 3 of this thesis proposes a conceptual model which synthesises the new knowledge established in Part1 and 2. A Mental Health Policy Development Model is proposed which brings together the policy literature and country experiences. It identifies the key content and process factors which need to be considered in mental health policy development and reform with particular application to developing countries and Newly Independent States. The model can be used by those wishing to more fully understand and undertake mental health policy development and reform. To my knowledge such work has not been undertaken in the area of mental health and constitutes a basis for further development in the field. Finally, the thesis acknowledges the formative nature of the work and makes suggestions for further research to build this knowledge ideally in partnership with other key mental health policy stakeholders throughout the world.

Global studies investigating scaling-up of mental health services have highlighted mental health policy development and implementation as a priority area, especially in low- and middle-income countries. This research aimed to investigate Malaysia's National Mental Health Policy (NMHP) development and implementation and explore the barriers and facilitators to mental health care from multi-stakeholder point of view. This study, consisting of two main parts, adopted the situation analysis model from the Global Mental Health Lancet 2011 Series. Part One details the current mental health plans and development of the NMHP with data obtained via semi-structured interview, consultation observation, and government documents analysis. Part Two investigates key stakeholder perceptions and/or experiences gained through semi-structured interviews with 54 participants across five main stakeholder groups: policymakers, service providers, NGOs, service users, and caregivers. These were analysed using content analysis and the Framework Method respectively. Six categories of types of mental health plans emerged: (1) 'action plans', (2) 'education and training', (3) 'operational', (4) 'community psychiatry', (5) 'promotion', and (6) 'NGO'. Further, stakeholders identified seven key areas in relation to mental health care: (1) 'barriers to mental health care', (2) 'suggestions for improvement', (3) 'awareness and knowledge on mental health', (4) 'facilitators to mental health care', (5) 'impact of mental illness', (6) 'duty of care', and (7) 'cultural spiritual or ethnic influence'. Findings indicate the extent to which the NMHP objectives and goals were achieved between 2009 and 2016. Issues around attitude, resources, and awareness are most pressing to address. Facilitating factors, as well as suggestions for improvements, were uncovered too. Further important considerations in providing care in Malaysia revolve around raising awareness and knowledge, cultural appropriateness, and the roles of family, friends and even NGOs. This study concludes with proposed needs- and asset-based recommendations for future national mental health policy development.

This thesis explores in which ways and why research informs and influences the public policy making process, and the extent to which existing theories and models add to our understanding of this. Since the late 1990s, the UK government has aspired to evidence-based policy making, particularly policy that is informed by research on what works. In practice, there are many barriers to this aspiration and the instrumental research use of 'what works' knowledge seems relatively rare. Existing research utilisation models offer some insights into why this is the case but they are not well supported by empirical evidence and they tend to underplay the complexities of the policy making process. Additional insights are provided by the literature on the policy process, but this does not pay much attention to research use. This thesis thus combines these perspectives. The thesis is guided by a conceptual framework that combines insights from the advocacy coalition framework (ACF), the stages heuristic, the research utilisation typology, practical rationality and the epistemic communities framework. Two qualitative case studies of Scottish national mental health policy making are considered using this conceptual framework: a suicide prevention policy and a review of mental health law. Data analysis combines 23 in-depth interviews and extensive document review. The ACF is used as a heuristic device to focus on aspects of the policy sub-system that are key to understanding research use. The findings demonstrate that despite limited research evidence on what works in mental health, research was used in the agenda setting and formulation stages of the policy making process, enriching the process and influencing policy sub-system dynamics. Five types of research use are identified; they do not occur in isolation but are layered and interlinked, and are at times contingent on one another. Research use is found to be bound up with the ways in which those involved in the policy making process work with others who share or oppose their policy beliefs, using similar or different knowledge bases. Research influenced policy beliefs, which in turn influenced policy making behaviour. Discussion of research enabled the inclusion, consideration and appreciation of new and different policy positions. It empowered weaker coalitions as well as cementing coalition dominance. It influenced policy direction and encouraged innovation and policy learning. The findings indicate that the current common usage of three categories of research use (instrumental, conceptual and political) may be too crude; real benefit was gained from applying Weiss' original seven research use types. Combining Weiss' research utilisation typology with the ACF deepened understanding of how research influences the policy making process. The findings only partially support the ACF hypotheses concerning research use, and they highlight weaknesses in a number of the ACF's assumptions and definitions. In terms of policy implications, the findings indicate a need to broaden governments' view of research use from an almost exclusive focus on the problem-solving use of 'what works' research knowledge to a wider appreciation of the ways in which research contributes to and enhances policy making.

Thesis (Ph.D.) - University of Glasgow, 2007. / Ph.D. thesis submitted to the Faculty of Medicine, Public Health and Community-Based Sciences, 2007. Includes bibliographical references. Print version also available.