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This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.

The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict).

A literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context.

The literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need; targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways.

This study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settings

The paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war.

This paper aims to examine reform of mental health legislation in England and Wales. It covers the period from the introduction of the 1983 MHA to the proposed reforms outlined in the Wessley Review that was published in December 2018.

This is a literature-based project.

Reform of the mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, and the other is the move to protect the civil rights of those who are subject to such legislation. The failures to development adequately funded community-based mental health services and a series of inquiries in the 1990s led to the introduction of Community Treatment Orders in the 2007 reform of the MHA.

The development of mental health policy has seen a shift towards more coercive approaches in mental health.

The successful reform of the MHA can only be accomplished alongside investment in community mental health services.

The paper highlights the tensions between the factors that contribute to mental health legislation reform.

The aim is to provide a brief overview of a series of articles tracing the emergence of several Mental Health Commissions (MHCs) in developed countries over recent years, sometimes to enhance mental health law administration, but often in connection with mental health reform strategies. The paper seeks to review the functions of, and elicit a framework for, Mental Health Commissions (MHCs) as effective vehicles for effective operation and reform of a mental health service system.

The approach of the paper is to identify the functions and limitations of Mental Health Commissions and then cluster them to form a typology of commissions.

There are broadly three types of MHCs: the first is more inspectorial and focussed on issues, concerns and complaints affecting the care of individuals, and is more restricted investigating the mental health service and the workings of mental health laws mainly to these ends; the second type is focussed on the entire mental health service system, including relevant all‐of‐government operations, concentrating on monitoring for and promoting system‐wide reform. While this appears to constitute a spectrum, with different MHCs mandated to work mainly at either end of it, there is conceivably a third type which has a combination of these functions. This occurs with some commissions, though an equal balance between these functions is unusual, so they usually can be assigned to a type on the basis of their predominant functions.

There was a limited sample size, obliging a non‐statistical descriptive analysis which may well affect the validity of these distinctions.

There is sometimes a combination of functions encompassing some features of both of these types. While type I MHCs can ensure that individual rights are upheld and that mental health laws and regulations are adhered to, to improve service quality, type II MHCs are likely to be more effective in achieving system‐wide mental health service reform.

MHCs can contribute to more holistic, evidence‐based and recovery‐oriented service delivery, which are more likely to lead to more desirable health and wellbeing outcomes for all mental health service users, their families and the community.

This typology provides a useful provisional framework for understanding the roles of MHCs in mental health services and in reform of the whole mental health service system and related systems.

Machinery of government changes and budget strategy are powerful levers to drive reform in the public sector. The purpose of this paper is to describe the rationale, progress and challenges in the establishment of Western Australia's Mental Health Commission in 2010 with policy, planning and purchasing powers to drive reform.

This case study is based on the observations of the author who had a lead role in the establishment of the Commission over its first two years. It sets this reform in the context of the whole of government reforms as well as demands for reform from stakeholders within the mental health sector.

It is demonstrated that externally imposed change is often necessary to fundamental reform. However, it also comes with risks of alienation of key stakeholders in powerful roles and an under‐estimation of the factors that will hamper change. Central government support has been essential to the establishment of the Commission.

The paper relies on the observations of a key participant in the reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access.

The paper identifies some of the practical strategies that mitigate the risks associated with system change.

This reform has been useful to showcase a range of other social policy reforms demonstrating the opportunities that strong political leadership offers when linked to policy and administrative change.

This analysis of the progress of reform highlights a range of issues that can inform other governments and community stakeholders undertaking major reform in the public sector as well as particular issues for reform in mental health.

The UK Government has been planning changes to mental health legislation for at least eight years. On 23 March 2006, the Department of Health announced that many of these plans would proceed ‐ although through amendments to the 1983 Mental Health Act rather than a substantive Bill. These proposed reforms are significant but controversial. This paper sets out some of the reasons for welcoming the proposed changes. It is argued that the proposals to replace the responsible medical officer with a clinical supervisor are in keeping with best quality mental health care, and allow for proper multidisciplinary practice. Such an approach explicitly permits proper use of the skills and competencies of the workforce ‐ including psychologists. A second controversial aspect of the proposed reforms ‐ supervised community treatment orders, permitting compulsory care outside of hospitals ‐ represent not a violation of human rights, but a specific defence of ‘Article 8’ rights to protection of family and personal life. Finally, it is argued that the proposed amendments are important because mental health legislation dominates mental health care and the present 1983 Mental Health Act inappropriately consolidates the status of the medical model and the role of the responsible medical officer (and hence psychiatry). It is argued that the proposed changes are imperfect; in particular they lack inclusion of an ‘impaired judgement’ criterion, but it is suggested that necessary role and service redesign needs such amendments to allow the new ways of working programme to ‘bite’.

Mental health reform needs to engage leaders across jurisdictions and governments/communities. This paper aims to describe the history leading to the establishment of the Australian National Mental Commission (the Commission) in 2012 and to identify opportunities/challenges in cross jurisdictional/sectoral reform of mental health services.

This case study is based on the observations of the author who has held lead state and national roles prior to leading the Commission. It sets the establishment of the Commission in the broader context of changing community attitudes, strong consumer/carer advocacy, increased financial support for mental health and establishment of state commissions.

Cross sectoral/jurisdictional reform needs leadership from government heads and central agencies. Risks relate to the need to effectively articulate state and national commissions and challenges accompanying multilateral stakeholders with high and often conflicting expectations, and tensions with other high priority issues that also require alignment between Federal and State leaders and agencies.

There may be potential bias based on the perspective of the narrator, and the benefits of direct experience in multiple jurisdictions.

The paper identifies critical success factors in the establishment/operation of the first national Commission and the establishment of relationships with state commissions, relevant to other cross jurisdictional bodies.

The paper provides an insight into the factors leading to the establishment of the first national Commission and its articulation with state commissions and the early operational challenges facing cross jurisdictional reforms in changing political climates.

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.

I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.

Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.

Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.

This article aims to describe the process by which the new NSW Government executed its election promise to establish a Mental Health Commission for NSW.

This case study draws on observations of the author who was expert facilitator to the Taskforce to establish the new NSW Commission. The paper synthesises the work of the Taskforce, the input of a consultation process that engaged more than 2,000 people, through six state‐wide community fora, online survey and other means. In describing the nature of the new NSW Commission, the paper will also reflect on key learnings from the Taskforce's interactions with other mental health commissions, including in New Zealand, Western Australia and Canada.

Widespread concern about the lack of access to quality mental health care was reflected in broad support for a new Mental Health Commission. Opinions varied about how such a new body could be effective. Strong bipartisan political support is key. Also critical is ensuring the new body has sufficient legislative power and reach.

This paper relies on the observations of a key participant in a reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access. The actual impact of the new NSW Mental Health Commission will only become apparent following its 1 July 2012 start‐up.

Many jurisdictions are turning to specialised governance models, such as a Commission, to drive mental health reform. This paper identifies some of the key issues to consider in pursuing this strategy.

Commissions need to have strong engagement with consumers, carers, service providers and the general community. This paper highlights some key issues in building these links.

The work of the Taskforce to Establish a NSW raised a range of issues relevant to any mental health reform process. Given the level of community concern about mental health care, these are important lessons.

An interview in which Professor Louis Appleby, CBE, reflects on his time as National Director for Mental Health and in particular the reforms to services for people with concurrent mental health and substance misuse problems.