Implementing mental health policy: some lessons from recent history

Last year, Centre for Mental Health was commissioned by NHS England to help the Mental Health Taskforce to explore what helps and what hinders the implementation of policies and strategies relating to mental health in England. From a review of literature and interviews and focus groups with people who have been responsible for policy implementation over the last 20 years, we identified 12 factors that influence the implementation of strategies. They are:

1. Money: strategies supported with extra funding have a greater chance of success, with funding for the process of change and the associated double running costs being particularly important.

2. Focus: strategies with a clear narrative and a small number of widely supported action points are more likely to succeed.

3. Targets: mainstream health policy continues to be driven, at least partly, by targets and incentives, and mental health strategies have benefited from close alignment with these, and struggled where they are not.

4. Scrutiny: visible accountability for achieving a strategy’s goals is essential to sustain implementation after early enthusiasm, both nationally and locally.

5. Passion and public opinion: strategies that enjoy support from the public and professionals, that resonate with people’s values and aspirations, are more likely to be implemented well.

6. Leadership: effective national and local leadership is vital for success. Collaborative leadership styles are likely to be more conducive to mental health policy implementation that requires multi-agency cooperation.

7. An engaged workforce: the most important changes are often the least amenable to policy-making and depend on the motivation of staff, while workforce planning and development are essential to translate ideas into practice.

8. Partnerships: locally and nationally, mental health policy relies on organisations working together, but this often means working against the grain of public sector systems, business processes and incentives.

9. Implementation support: robust, stable and supportive implementation infrastructure is vital to help local areas to translate policy into achievable actions, and to facilitate learning from one locality to another.

10. Innovation, evaluation and adaptation: policy cannot stand still; it needs to enable innovation, to learn from its successes and failures, and to adapt to changing circumstances.

11. Management: good quality project management is essential for local areas to implement change.

12. Time: changing practice takes longer than policy-makers think. Policies need time to get implemented effectively; and investing in time to get processes right is crucial for success.

Based on the evidence gathered in this review, we made recommendations to the Taskforce about how to ensure its proposals have the best possible chance of being implemented widely and effectively. They included calling on the Government and the NHS to ensure that sufficient funding is made available to achieve the Taskforce’s recommendations. This should include investing in a robust and stable implementation support system for the Taskforce recommendations and support for local leaders and partnership and management arrangements.

The report also call for action to ensure that mental health is given equal prominence in all new and existing policy implementation mechanisms. And it says that NHS England should put in place robust, real-time evaluation mechanisms for the implementation of this report: which few previous mental health strategies have had.

With the Mental Health Five Year Forward View now published, history suggests that we need concerted action now to ensure that its promises are delivered. Mental health strategies never exist in isolation. They can be helped or hindered by broader health policies and a range of other influences. Only by ensuring both that mental health is given sufficient prominence in the new Sustainability and Transformation Plans and that money earmarked for mental health support is actually spent on it will we see the kind of changes the Taskforce recommended happening across the country.

Recent history shows that implementing mental health policy as intended is never straightforward. Among other things it takes effort, commitment, flexibility, accountability, money and time. It is possible to make an impact but it will not be easy. The really hard work starts now.

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