Britain and Sweden have had similar backgrounds when it comes to organising treatment of Mentally Disordered Offenders who are sentenced to forensic psychiatric care instead of prison. Traditionally care has been centrally controlled and isolated from mainstream healthcare structures. However since the 1980s, both countries have had similar stated policy objectives of wanting to integrate services for forensic psychiatric treatment into general healthcare structures. Both countries have regionally organised healthcare with decisions on treatment provision made by the regional organisation. The term integration suggests that forensic services would be decentralised to Health Authorities in the same way as other healthcare services. Yet these seemingly similar policy objectives have resulted in very different outcomes. This leads to a puzzle, what is the explanation for the differing outcomes? This study aims to explain the reason(s) for the different outcomes by tracing the causative process using a comparative case-study method. The study demonstrates that both political institutions and service culture explain why Sweden was able to decentralise forensic psychiatric treatment but not Britain.

Public sector reforms of recent decades in Europe have promoted managerialism and aimed at introducing private sector thinking and practices. However, with regard to public sector executives' self-understanding, managerial role identities have not replaced bureaucratic ones; rather, components from both paradigms have combined. In this article, we introduce a bi-dimensional approach (attitudes and practices) that allows for different combinations and forms of hybridity. Empirically, we explore the role identities of public sector executives across Europe, building on survey data from over 7,000 top public officials in 19 countries (COCOPS survey). We identify country-level profiles, as well as patterns across countries, and find that administrative traditions can account for these profiles and patterns only to a limited extent. Rather, they have to be complemented by factors such as stability of the institutional environment (indicating lower shares of hybrid combinations) or extent of reform pressures (indicating higher shares of hybrid combinations).