Incremental change without policy learning: Explaining information rejection in English mental health services

Abstract

This paper reviews recent policy changes in English mental health services and the nature of the evidence base that has guided these changes. In particular, the paper focuses on different groups within mental health policy and practice, citing examples of information rejection by each of the key stakeholders. Drawing on a neo-Durkheimian institutionalist framework, the paper argues that each group classifies the world, remembers and forgets, and rejects the information that they do, in order to solve or at least to cope with the organizational challenges and pressures they face, which in turn are the product of informal institutions. As a result of this, the ideas and assumptions underpinning English mental health policy have remained remarkably consistent over time, due in part to the fact that different stakeholders have been institutionally disposed to hear only a limited range of messages from the growing evidence base and correspondingly find it very difficult to engage in constructive debate with each other or reach consensus.