Development of a model for the implementation and evaluation of citizen-user involvement in mental health policymaking: A case study

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Restall, Gayle
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The purpose of this research was to develop a model for the implementation and evaluation of citizen-user involvement in mental health policymaking. The study explored the pathways through which the experiential knowledge of citizen-users enters policy processes, how the outcomes of citizen-user involvement are conceptualized by policy actors, and the contextual factors that influence the implementation and outcomes of involvement. Qualitative instrumental case study methodology was used to focus on the policy field of mental health and social housing. Data were collected through key informant interviews with a purposive sample of 21 people recruited from four policy actor groups: citizen-users, representatives of advocacy organizations, government officials (elected representatives and bureaucrats), and service providers. A review of policy documents as well as forum, committee and task force reports provided additional data for the study. The research built on a previous study that developed a model of the important processes that are used to engage citizen-users in decisions about services and policies. Findings from the current study built on this model by exploring the outcomes, pathways and contexts of involvement from the perspectives of policy actors. Four categories of outcomes were identified: substantive, instrumental, normative and personal. Benefits and risks of involvement were identified within each category. Participants described direct and indirect pathways through which the voices of citizen-users have gained access to policymaking. Direct pathways were those through which individual and collective voices of citizen-users have communicated directly with decision makers. Indirect pathways represented the ways in which the voices of citizen-users were mediated by other policy actors. The findings also highlighted five contextual factors that have influenced citizen-user involvement: the socio-political environments, institutional characteristics, participant characteristics, opportunities to be involved and other influences on policymaking. This research has added to knowledge about the important components of citizen-user involvement in policymaking. The results provide guidance to policy actors about ways to enhance involvement. People with mental health and social housing needs have important experiential and other knowledge to contribute to policymaking. The challenge is the ongoing search for the means to ensure that their voices are heard and carry weight.
health policy, mental health, citizen engagement
Restall, G., & Strutt, C. (2008). Participation in planning and evaluating mental health services: Building capacity. Psychiatric Rehabilitation Journal, 31, 334-338.