Steering stategies of mental health reforms in Sweden and England compared
I a new PhD thesis from Uppsala University steering strategy choice is studied using a comparative case study of the mental health reforms in Britain and Sweden between 1990 and 2005.
Why do governments choose to use certain strategies for steering reform implementation by municipalities, health authorities and other agencies while other steering strategies are ignored? Public management reforms such as New Public Management in many Western countries have meant that although welfare-service reforms are decided at the national level by government and parliament – implementation is often devolved to local levels and actors. Thus governments lack a direct influence over the services that reform users receive. Therefore, the main mechanism for governments to influence the implementation of national reforms is though the selection of steering strategies and instruments to fill the “Governance Gap” between central and local actors.
This PhD thesis studies steering strategy choice using a comparative case study of the mental health reforms in Britain and Sweden between 1990 and 2005. Despite strong similarities in the reforms’ aims and contents, there were differences in the steering strategies selected: Britain selected hard steering-strategies and instruments whereas Sweden chose soft. The study analyses three dimensions, a Triad of Influences, which may assist understanding what influences the state’s governance and steering choices. The first is Administrative Traditions whereby historical, institutional and constitutional legacies can form path dependencies that influence modern steering choices. Secondly, Professions are studied, as professions may have a strong influence over reforms whereby the state transfers reform responsibility to professions and grants extensive discretion and freedom from steering granted to professions by the state. Finally Policy Framing is considered, and the way that states use ‘causal stories’ to frame the policy problems and users in a particular way, thus creating preferences for certain government steering strategies.
The study shows that Administrative Traditions were an important influence on steering choices for the mental health reforms. However in contrast to previous research, the study found that these administrative and institutional explanations do not appear to account for all of the differences in steering choices. In particular the underlying Policy Framing of the care ideology used to justify the need for state action in the policy area, also appears to influence steering strategy. The Professions dimension gave more mixed results in the case of the mental health reforms and may require more theoretical development or may be linked to the low status of municipal social work that resulted in limited influence.