The International Consortium on Mental Health Policy and Services: objectives, design and project implementation

The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network-the International Consortium on Mental Health Policy and Services-are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.

Managerialism and Public Housing Reform

This paper discusses market inspired changes to the delivery of public housing in Queensland, Australia during the late 1990s. These policy changes were implemented in an organisational environment dominated by managerialism. The theory and method of critical discourse analysis is used to examine how managerial subject positions were assimilated and/or creatively resisted by different actors within the public housing policy community. These themes are discussed using interview data with a range of policy actors, including policy managers, front-line housing staff and public housing tenants. The analysis suggests that policy actors who openly challenged the emerging policy and organisational direction were marginalised in changing power relations.

The Mental Health Policy Template: Domains and elements for mental health policy formulation

Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999-2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001-2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.

Think global, act global: Corporate content streaming and Australian media policy

Australia ’s media policy agenda has recently been dominated by debate over two key issues: media ownership reform, and the local content provisions of the Australia–United States Free Trade Agreement. Challenging the tendency to analyse these issues separately, the article considers them as interlinked indicators of fundamental shifts occurring in the digital media environment. Converged media corporations increasingly seek to achieve economies of scale through ‘content streaming’: multi-purposing proprietary content across numerous digitally enabled platforms. This has resulted in rivalries for control of delivery technologies (as witnessed in media ownership debates) as well as over market access for corporate content (in the case of local content debates). The article contextualises Australia’s contemporary media policy flashpoints within international developments and longer-term industry strategising. It further questions the power of media policy as it is currently conceived to deal adequately with the challenges raised by a converging digital media marketplace.

The communication rights in the information society (CRIS) campaign: Applying social movement theories to an analysis of global media reform

Social movement theories offer useful conceptual and analytical tools to the study and research of global media reform movements. This article is a critical analysis of the Communication Rights in the Information Society (CRIS) campaign. It explores its successes and blind-spots in the light of social movement theory, in particular resource mobilization theory (RMT), and offers practical directions for the movement to move on from where it is to where it ought to be.

Fast-tracking middle schooling reform: A model for the integrated curriculum

To participate effectively in the post-industrial information societies and knowledge/service economies of the 21st century, individuals must be better-informed, have greater thinking and problem-solving abilities, be self-motivated; have a capacity for cooperative interaction; possess varied and specialised skills; and be more resourceful and adaptable than ever before. This paper reports on one outcome from a national project funded by the Ministerial Council on Education, Employment Training and Youth Affairs, which investigated what practices, processes, strategies and structures best promote lifelong learning and the development of lifelong learners in the middle years of schooling. The investigation linked lifelong learning with middle schooling because there were indications that middle schooling reform practices also lead to the development of lifelong learning attributes, which is regarded as a desirable outcome of schooling in Australia. While this larger project provides depth around these questions, this paper specifically reports on the development of a three-phase model that can guide the sequence in which schools undertaking middle schooling reform attend to particular core component changes. The model is developed from the extensive analysis of 25 innovative schools around the nation, and provides a unique insight into the desirable sequences and time spent achieving reforms, along with typical pitfalls that lead to a regression in the reform process. Importantly, the model confirms that schooling reform takes much more time than planners typically expect or allocate, and there are predictable and identifiable inhibitors to achieving it.

No more free beer tomorrow? Economic policy and outcomes in Australia and New Zealand since 1984

There are no controlled experiments in macroeconomic policy, nor in systematic programs of microeconomic reform, but a comparison between New Zealand and Australia over the period since 1984 provides as close an approach to such an experiment as is ever likely to be possible. From quite similar starting points the two countries pursued liberal reform programs that differed sharply, mainly as a result of exogenous differences in constitutional structures and the personal styles of the central actors. Australia followed a more cautious, piecemeal, consensus-based approach, whereas New Zealand, in contrast, adopted a radical, rapid, 'purist' platform. The NZ reform package was generally seen by contemporary commentators as representing a 'textbook' model for best practice reform. However, Australia since 1984 has performed much better than New Zealand, whose per capita GDP growth indeed ranked at or near the bottom of the OECD. In this paper, we assess a variety of explanations for the divergences in policies and outcomes.

Administering Welfare Reform: International Transformations in Welfare Governance

While reforms of welfare policies have been widely analyzed, the reform of welfare administration has received far less attention. Using empirical case studies, this book provides significant new insights into the way welfare administration is being internationally transformed. Particular attention is given to the effect on welfare clients, staff, and agencies. The book presents a critical analysis of governance practices in welfare administration, examining shifts in the participants, practices, and processes. Administering Welfare Reform provides a much-needed international and comparative perspective of changing welfare governance.

Exploring innovation in policy-making within central government:the case of the UK's Highways Agency

The first and main contribution of this article is its access to the decision-making processes which drive innovation in policy-making within central government. The article will present a detailed case history of how the innovation came about and conclude by highlighting analytic possibilities for future research. The policy in focus is the UK’s Traffic Management Act 2004, which passed responsibility for managing incidents on major roads from the police to the Highways Agency (HA), and has been interpreted as a world first in traffic management. The article tracks the Traffic Management Act 2004 from problem identification to a preliminary evaluation. It is then suggested that future research could explain organizational change more theoretically. By taking a longitudinal and multi-level approach, the research falls into a processual account of organizational change. The second contribution of the article is to highlight two novel ways in which this approach is being applied to policy-making, through an institutional processualist research programme on public management reform and empirical investigations using complex systems to explain policy change.

Professionals, discretion and public sector reform in the UK:re-visiting Lipsky

Purpose – Seeks to examine how far Michael Lipsky's theory of discretion as it relates to public sector professionals as “street-level bureaucrats” is still applicable in the light of public sector reform and in particular the introduction of increased managerial control over professionals. Design/methodology/approach – The main thesis in Lipsky's work, Street-Level Bureaucracy, that street-level bureaucrats devise their own rules and procedures to deal with the dilemmas of policy implementation is linked to public sector reform over the past 25 years or so. The article differentiates between three forms of discretion, rule, task and value and assesses the extent to which these different forms of discretion have been compromised by reform. Examples are drawn principally from the literature on school teachers and social workers Findings – The findings suggest that the rule-making (hence bureaucratic) capacity of professionals at street-level is much less influential than before although it is questionable whether or not the greater accountability of professionals to management and clarity of the targets and objectives of organisations delivering public policy has liberated them from the dilemmas of street-level bureaucracy. Research limitations/implications – The work has focussed on the UK and in particular on two professions. However, it may be applied to any country which has undergone public sector reform and in particular where “new public management” processes and procedures have been implemented. There is scope for in-depth studies of a range of occupations, professional and otherwise in the UK and elsewhere. Practical implications – Policy makers and managers should consider how far the positive aspects of facilitating discretion in the workplace by reducing the need for “rule-making” to cope with dilemmas have been outweighed by increased levels of bureaucracy and the “de-skilling” of professionals. Originality/value – Lipsky's much cited and influential work is evaluated in the light of public sector reform some 25 years since it was published. The three forms of discretion identified offer the scope for their systematic application to the workplace.

Reform of the New Zealand Health System:problematization, mobilization and change

This paper will seek to explicate the changes in the New Zealand health sector informed by the concepts of problematization, inscription and the construction of networks (Callon, 1986; Latour, 1987, 1993). This will involve applying a framework of interpretation based on the concepts of Latour's sociology of translation. Material on problematization and inscription will be incorporated into the paper in order to provide an explanatory frame of reference which will enable us to make sense of the processes of change in the New Zealand health sector. The sociology of translation will be used to explain the processes which underlie the changes and will be used to capture effects, such as changes in policy and structure, producing new networks within which 'allies' could be enrolled in support of the health reforms.