Social Science and Public Policy

Richard Freeman

backpublications - mental health policy

Knowledge, policy and coordinated action: mental health in Europe
Freeman, R and Sturdy, S

As a knowledge-based international agency, WHO offers a useful opportunity to explore the nature of knowledge in policy making. Between 12 and 15 January 2005, a WHO Ministerial Conference on Mental Health in Europe took place in Helsinki: the Declaration and Action Plan it approved quickly became a touchstone for subsequent developments in mental health policy in Europe. Our discussion sets out just how embodied, inscribed and enacted knowledges are deployed in the production, development and dissemination of a policy initiative.

Publication Type: chapter in book      Source: Bristol: Policy Press
Date: 2015       Link: http://www.policypress.co.uk/display.asp?k=9781447309987


Reciprocal instrumentalism: Scotland, WHO Europe, and mental health
Smith-Merry, J, Freeman, R and Sturdy, S

This paper explores the relationship between the World Health Organization’s Regional Office for Europe (WHO Europe) and Scotland in the context of mental health. Since devolution Scotland has gained autonomy as a constituent country of the United Kingdom and has developed a reputation for progressive mental health policy. Scotland has also become increasingly involved in WHO, notably in the development of the Mental Health Declaration for Europe. In this paper we examine the interactions that regulate the relationship between these two actors in order to determine how and why the relationship was built. Our analysis draws on interviews with individuals involved in the development of the Declaration and its accompanying Action Plan alongside an analysis of related texts. We observe that the relationship between Scotland and WHO was created and perpetuated through personal communication, meetings and the joint production of documents, in a way that mutually validated the policy aims and agenda of both actors.

Publication Type: journal paper      Source: International Journal of Public Policy 9 (4/5/6) 260–276
Date: 2013       Link: http://www.inderscience.com/jhome.php?jcode=ijpp


Making knowledge for international policy: WHO Europe and mental health policy, 1970-2008
Sturdy, S, Freeman, R and Smith-Merry, J

It is widely agreed that the effectiveness of the World Health Organization (WHO) as a policy body derives chiefly from its reputation as a source of authoritative knowledge. However, little has been done to show just how WHO mobilises knowledge for policy purposes. Rather, commentators tend simply to assume that the WHO is a technocratic organisation, which uses technical expertise to define normative, universally-applicable standards on which to base policy. This paper tells a rather more complex story. Looking in detail at the efforts of the WHO European Regional Office, since the 1970s, to reform mental health policy across the region, it shows that the organisation’s main policy successes in this field were achieved, not by circulating standardised data or policies, but by creating opportunities to share holistic, experience-based and context-sensitive knowledge of instances of best practice. We go on to analyse our findings in light of ideas about 'epistemic communities', and show how an appreciation of the nature and constitution of epistemic communities can illuminate the different ways that knowledge may inform international policy.

Publication Type: journal paper      Source: Social History of Medicine, forthcoming
Date: 2013


Reverb: policy making in wave form

When we think of policy as mobile, what is it we think is moving? Asking after the mobility of policy is important not least for the ontological questions it raises: what is policy such that it moves? Ordinarily, we might think of policy as existing in time and space while, given certain conditions, some policies move from one time and/or space to another. This paper, by contrast, begins by describing policy as resulting from movement, setting out a model or heuristic which takes its mobility as prior to its existence. For policy is made in communicative interaction, both oral (in meetings) and textual (in documents). We might think of it in wave form, which helps to explain both its mobility and its mutability. The paper illustrates this conception in a study of WHO activity in respect of mental health in Europe, exploring aspects of translation - understood as the generation of messages in interaction - and of iteration, as those messages are reformulated and repeated in different contexts. The policy concept reverberates, and it is in this way that collective sense is consolidated and reproduced.

Publication Type: journal paper      Source: Environment and Planning A 44 13-20
Date: 2012       Link: http://www.envplan.com/contents.cgi?journal=A&issue=current


Rhizomic regulation: mobilising knowledge for mental health in Europe
Freeman, R, Smith-Merry, J and Sturdy, S

Regulation depends fundamentally upon the production and dissemination of knowledge. At a minimum, one might imagine a mechanical model of regulation which involves regulator A exerting control over the actions of actor B. But even here, knowledge is crucial, for B must know what kinds of actions A requires or considers appropriate if regulation is to occur. And A must ensure that its preferences are communicated effectively, in a form that B can comprehend and act upon. In real world situations, the knowledge problems associated with regulation are of course much more complex than this. Regulators need to have knowledge of the domain they are regulating, including the aims, interests and capacities of the various actors who inhabit that domain. Actors need to know how the regulators’ communications are to be interpreted, and what penalties they might face if they act incorrectly. And regulators and actors alike need to constantly update their knowledge of the system as a whole, and of how effectively regulation might be working to ensure that their interests are fulfilled. Regulation, in short, depends on the constant generation, circulation, interpretation and evaluation of knowledge. This chapter duly reports and discusses the findings of a study of the work of the World Health Organization (WHO) in defining the content of mental health policy in Europe.

Publication Type:       Source: Barroso, J and Carvalho, L M (eds) Knowledge and Regulatory Processes in Health and Education Policies, Lisbon: EDUCA
Date: 2012


Stakeholder consultation and social mobilization: framing Scottish mental health policy
Sturdy, S, Smith-Merry, J and Freeman, R

Public and stakeholder consultation is increasingly important in the policy process, both in the UK and elsewhere. Social scientists have considered consultation primarily in terms of how it relates to decision-making – either as a means of involving a wider constituency of actors in the decision-making process, or as a means of legitimizing the decisions taken by policymakers. This article shows that consultation can also serve a rather different role in relation to policy: as, in effect, the first stage in policy implementation. Based on direct observation of a stakeholder consultation on Scottish mental health policy that took place during late 2007 and early 2008, it draws on elements of social movement theory to show how that consultation served as a means of enrolling, orienting and mobilizing stakeholders to implement a largely pre-existing set of policy aims.

Publication Type: journal paper      Source: Social Policy and Administration 46 (7) 823-844
Date: 2012       Link: http://onlinelibrary.wiley.com.ezproxy.webfeat.lib.ed.ac.uk/doi/10.1111/j.1467-9515.2012.00848.x/abstract


'Policy opportunities'

What is policy? How do we do or make policy? Where and who with? What is it for, anyway, and what difference does it make? Good questions, though you wouldn't be asking them if you didn't already know that answering them isn't easy. You've read and heard a lot of stuff which seems to be called 'policy', and some other stuff which seems to be about 'the policy process', and you still have these questions. Forgive me, then, for wondering whether questions and answers are going to take us very far. I'd really like to know why you're asking, because then I think we'd get into conversation. Because we've never met, I'm going to have to imagine what you'd say and what I'd say in return. So what follows here is an imagined and implied conversation, in which you tell me the story of your first foray into policy making and I try to make sense of it...

Publication Type: chapter in book      Source: Global Mental Heath: Trauma and Recovery, A companion guide for field and clinical care of traumatized people worldwide, Cambridge MA: Harvard Program in Refugee Trauma
Date: 2011       Link: http://hprt-cambridge.org/?page_id=641


Introduction
Freeman R and Rowe, M

We are concerned here with community psychiatry, a particular way of knowing and thinking about mental illness and of responding to it. Community psychiatry, for our purposes, refers to all the policies, services, agencies and staff deployed in treating people with mental health problems who are poor and for whom publicly-funded services are the default, if not the only, option. Community psychiatry is public psychiatry. Our first purpose is educational, to set out for ourselves and others what community psychiatry is and has been, where it has come from, and where it might go. Our immediate aim is to explain how we think of community psychiatry, why we began this project, and how we set about it.

Publication Type: chapter in book      Source: forthcoming in Rowe, M, Thompson, K, Lawless, M and Davidson, L (eds) Classics of Community Psychiatry: fifty years of public mental health outside the hospital, Oxford: Oxford UP
Date: 2011


 

Transformation of a mental health system – the case of Scotland
Smith-Merry, J, Freeman, R and Sturdy, S

System transformation in mental health is of immediate concern across countries throughout Europe and beyond. In this paper we describe a paradigm shift in Scottish policy from the control of psychiatric disorder to mental health governance and explore the means by which it has been supported and sustained. No longer characterised by outdated legislation, poor communication and a very limited policy framework, mental health policy in Scotland is held up as exemplary by the World Health Organization, the European Commission and other international actors. We identify four key factors in this structural transformation: 1) a renewed institutional mandate for mental health at the moment of devolution; 2) a commitment to consultation and communication both among mental health actors and agencies and with a wider public; 3) the use of information in performance management and, 4) the degree of reflexivity fostered by engagement in international networks.

Publication Type: draft paper      Source:
Date: 2011       Link: http://www.richardfreeman.info/contact.php?title=Transformation of a mental health system: the case of Scotland


Implementing recovery: an analysis of the key technologies in Scotland
Smith-Merry, J, Freeman, R and Sturdy, S

Background: Over the past ten years the promotion of recovery has become a stated aim of mental health policies within a number of English speaking countries, including Scotland. Implementation of a recovery approach involves a significant reorientation of mental health services and practices, which often poses significant challenges for reformers. This article examines how four key technologies of recovery have assisted in the move towards the creation of a recovery-oriented mental health system in Scotland. Methods: Drawing on documentary analysis and a series of interviews we examine the construction and implementation of four key recovery 'technologies' as they have been put to use in Scotland: recovery narratives, the Scottish Recovery Indicator (SRI), Wellness Recovery Action Planning (WRAP) and peer support. Results: Our findings illuminate how each of these technologies works to instantiate, exemplify and disseminate a 'recovery orientation' at different sites within the mental health system in order to bring about a 'recovery oriented' mental health system. They also enable us to identify some of the factors that facilitate or hinder the effectiveness of those technologies in bringing about a change in how mental health services are delivered in Scotland. These finding provide a basis for some general reflections on the utility of 'recovery technologies' to implement a shift towards recovery in mental health services in Scotland and elsewhere. Conclusions: Our analysis of this process within the Scottish context will be valuable for policy makers and service coordinators wishing to implement recovery values within their own national mental health systems.

Publication Type: journal paper      Source: International Journal of Mental Health Systems 5:11
Date: 2011       Link: http://www.ijmhs.com/


 

Knowledge in policy: embodied, inscribed, enacted
Freeman, R and Sturdy, S

The literature on the role of knowledge in policy making encompasses a striking diversity of views on just what knowledge is, what different types of knowledge there may be and how they are to be observed empirically. In this paper, we propose a new phenomenology of knowledge based not on 'who knows what, how, why' but on the form that knowledge takes. Drawing a simple analogy with the three phases of matter - solid, liquid and gas - we argue that knowledge, too, exists in three phases, which we characterise as embodied, inscribed and enacted. And just as matter may pass from one phase to another, so too knowledge can be transformed, through various kinds of action, between phases. After reviewing the literature on knowledge and policy, we elaborate this three-phase model in the third section of our paper below. Our argument is illustrated and elaborated through a case study of the World Health Organization (WHO) in Europe. As a knowledge-based organization, it offers a useful opportunity to explore the nature of knowledge in policy making; in doing so, we ground our theoretical model in empirical observation. We conclude by discussing the implications of our perspective for future work both in research and policy.

Publication Type: draft paper      Source:
Date: 2011       Link: http://www.richardfreeman.info/contact.php?title=Knowledge in policy: embodied, inscribed, enacted


 

Les transformations du système de santé mentale: l'exemple de l'Ecosse
Smith-Merry, J, Freeman, R and Sturdy, S

System transformation in mental health is of immediate concern across countries throughout Europe and beyond. In this paper we describe a paradigm shift in Scottish policy from the control of psychiatric disorder to mental health governance and explore the means by which it has been supported and sustained. No longer characterised by outdated legislation, poor communication and a very limited policy framework, mental health policy in Scotland is held up as exemplary by the World Health Organization, the European Commission and other international actors. We identify four key factors in this structural transformation: 1) a renewed institutional mandate for mental health at the moment of devolution; 2) a commitment to consultation and communication both among mental health actors and agencies and with a wider public; 3) the use of information in performance management and, 4) the degree of reflexivity fostered by engagement in international networks. [In French: English version available as draft paper]

Publication Type: journal paper      Source: Revue Sociologie Santé 34 143-164
Date: 2011


 

Indicating Mental Health in Scotland
Smith-Merry, J, Sturdy, S and Freeman, R

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2010       Link: http://www.knowandpol.eu/index.php?id=257


 

Recovering Mental Health in Scotland: 'recovery' from social movement to policy goal
Smith-Merry, J, Freeman, R and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2010       Link: http://www.knowandpol.eu/index.php?id=256


 

WHO, Mental Health, Europe
Freeman, R, Smith-Merry, J and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link: http://www.knowandpol.eu/index.php?id=257


 

Towards a Mentally Flourishing Scotland: consultation process as public action
Smith-Merry, J, Freeman, R and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link: http://www.knowandpol.eu/index.php?id=256


 

Scotland, Mental Health and WHO
Smith-Merry, J, Freeman, R and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link: http://www.knowandpol.eu/index.php?id=257


 

The Fabrication, Circulation and Use of Knowledge-based Regulatory Instruments in European Countries
Afonso, N, Carvalho, L, Costa, E, Freeman, R, Smith-Merry, J and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link: http://www.knowandpol.eu/index.php?id=257


 

Mental health policy making in Ethiopia
Freeman, R and Wondimagegn, D

Publication Type: research report      Source: The Scottish Government
Date: 2008       Link: please mail to: dawitwondi@yahoo.com


Organizing mental health in Scotland
Smith-Merry, J, Freeman, R and Sturdy, S

This paper reports the first phase of a research project on mental health policy in Scotland that investigates the way knowledge is mobilised in the policy process. In this first phase of the project, the authors’ concern has been to map the organisational domain of mental health policy in Scotland, paying attention to the form and structure of agencies and organisations as well as to the relationships between them. The paper describes a set of organisations in which central government is dominant but notes also a range of organisational forms and functions, and a diversity of sources of knowledge, expertise and information on which they draw. A dense network of linkages between agencies is identified.

Publication Type: journal paper      Source: Mental Health Review Journal 13 (4) 16-26
Date: 2008       Link: http://pierprofessional.metapress.com/content/g0ktxq132335/?p=38671b3eb6fe4958857b5e49623b7cd8&pi=4


 

Scottish Mental Health Policy: context and analysis
Smith-Merry, J, Freeman, R and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2007       Link: http://www.knowandpol.eu/index.php?id=245


Pathways through care: the experience of psychiatric patients
Spicker, P, Anderson, I, Freeman, R and McGilp, R

The aim of this project was to identify the pathway through psychiatric care beyond the point of first admission. This was carried out from the point of view of users, considering the pathway as a set of subjective experiences. Fifty interviews were conducted with people undergoing psychiatric care in a range of service settings, using a semi-structured interview schedule. Although the research was initially conceptualised in terms of pathways, the routes followed by patients proved to be too diffuse to be charted. Some patient careers were both prolonged and erratic. Patients do not follow a definite pathway; rather, they move through a set of complex stages which are often unclear. If respondents lack a subjective sense of a pathway, they feel, at least in part, that it is because they do not know what is happening.

Publication Type: journal paper      Source: Health and Social Care in the Community 3 (6) 343-352
Date: 1995       Link: http://www3.interscience.wiley.com/journal/119222793/abstract


 

User perspectives on psychiatric services: a report of a qualitative survey
Spicker, P, Anderson, I, Freeman, R and McGilp, R

Publication Type: journal paper      Source: Journal of the Association for Quality in Health Care 3 (2) 65-72
Date: 1995


 

Discharged into the community: the experience of psychiatric patients
Spicker, P, Anderson, I, Freeman, R and McGilp, R

Publication Type: journal paper      Source: Social Services Research 1995 (1) 27-35
Date: 1995       Link: http://www.richardfreeman.info/contact.php?title=Discharged into the community: the experience of psychiatric patients


 

Pathways through Psychiatric Care. Identification of pathways through care by examination of the experiences of psychiatric patients
Spicker, P, Anderson, I, Freeman, R and McGilp, R

Publication Type: research report      Source: Tayside Health Board
Date: 1993


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