Abstract
Abstract This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient care and expanding community mental health systems, on policy and programmatic decision making. A central focus of the study involves the trade-offs between and efforts to integrate shared decision making with evidence-based planning methods within the context of a national psychiatric reform strategy, particularly one involving a former Soviet bloc state. Given the uniqueness of the Czech experience, an exploratory case study methodology is used, one involving ten interviews with key informants and examination of a wide variety of documents. Results include the development of broad new decision and oversight structures, and the initial implementation of community mental health services. The nation faces some of the same trade-offs found elsewhere, such as in the United States, between an inclusive participatory process, and one that systematically incorporates empirical rational and evidence and best practices within bounded parameters. Implications for new psychiatric deinstitutionalization initiatives are identified, including development of a national mental health authority, a professional workforce, new funding strategies, multi-level service coordination, mechanisms to assure transparency, among others.
Highlights
Because of the increasing attention to global mental health policy issues, especially psychiatric deinstitutionalization and mental health system development, there have been numerous national efforts to update mental health programmes through psychiatric reform initiatives (Shen & Snowden, 2014)
In the Czech Republic, a major reform initiative, supported by the European Union’s Structural Funds (ESF) programme, has focused on the reform of decision-making processes, and key questions addressed in this research involve the current and envisioned systems for allocating and planning public mental health resource deployment, and the strategy for its reform
The interview included a variety of questions, which were organized in the following categories: (i) Role(s) and background of the respondent; (ii) organizational context of mental health programme; (iii) mental health service system; (iv) governmental planning processes for mental health; (v) decision-making procedures; (vi) programme evaluation; (vii) criteria and principles used in decision making; (viii) budgeting and financial planning; (ix) roles of non-governmental groups; (x) overall assessment of process and concluding questions
Summary
Because of the increasing attention to global mental health policy issues, especially psychiatric deinstitutionalization and mental health system development, there have been numerous national efforts to update mental health programmes through psychiatric reform initiatives (Shen & Snowden, 2014) This has been the case in the former soviet bloc nations (Dobiasova, et al, 2016; Tomov, Van Voren, & Keukens, 2007) such as the Czech Republic, which have been working to overcome many years of over reliance on institutional care and neglect of community support services (Dlouhy, 2014; Dlouhy, & Bartak, 2013). Trade-offs, whether or not they have been necessary, between these considerations have been observed in a variety of studies (Hudson, 1992)
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