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Check out the way it shouldn‘t be managed: mental health policy development and outcomes

Review

The article presents results of the qualitative experts' research which was conducted in 2012–2013 within the frame of a project "Challenges of Implementation of Lithuanian Mental Health Policy". The article analyzes development of the Lithuanian mental health care system from the perspectives of its' supporters and critics. Special attention is drawn on the relationship between practices inherited from the Soviet time and modern innovations which are slowly gaining momentum. Authors of the article come to the conclusion that the mental health care system is based on out-dated principles and that it is unable to adequately respond to chronic and newly emerging problems; despite of these obvious failures in the implementation level mental health reform never appears on the political agenda as a serious issue of a strategic level to be discussed.
Non-governmental organizations pilot and introduce new mental health services which are distinguished by their innovative nature, and incompatibility with the general stagnating context within the mental health care system. The inert system perceives these innovations as threats to its' homeostasis and reacts in the traditional direction towards its restoration: a) either new services are financially and institutionally suppressed as unjustified and the system returns to its equilibrium; or (b) new services become integrated into customary systemic practices thus strengthening the former institutional design.
Researchers also distinguish between the two types of stakeholders within the mental health care system, who differ significantly in understanding of the status quo and the future of the system. One group is represented by long-term representatives of the system (politicians, officials, directors of institutions), the second group is represented by reformers of the system (members of NGOs, academics, relatives of service users). The first group dominates in the process decision making and implementation whereas role of the second group in the policy making process remains very small.

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