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All Vision but No Change?

All Vision but No Change?

Helen Johnston

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Determinants of Implementation: The Case of Ireland and Mental Health Policy

Many acclaimed policies in Ireland have failed to deliver on their aspirations, leading some commentators to talk of a problem of implementation. The failure to fully implement some public service policies has led to frustrations on the part of policymakers, service providers and service users alike.

This book reviews the implementation literature from a number of perspectives. There are those who seek to implement policy from the 'top down'. Others seek to influence the implementation of policy from the 'bottom up'. Some seek to bring about implementation through change. The mental health policy A Vision for Change is taken as a case study. The content of reports of an Independent Monitoring Group is analysed. Interviews are undertaken with people associated with implementation of the policy. These include politicians, public servants, mental health professionals, mental health service users and mental health advocates.

The key finding is that two factors were found to be fundamental to successful implementation:

(1) authoritative, accountable leadership; and
(2) identifying and addressing the main resisters to change. Many other factors were found to be important to some extent.

The book concludes that there is a need to acknowledge issues 'below the surface', including beliefs, values and power relationships in implementing policies. Innovation and creativity, along with local leadership, are important but on their own they are not enough to ensure successful implementation. These findings have relevance for the implementation of nationally designed policies which are intended to be implemented across the country in an even-handed way.


1 Introduction 

Rationale for the research
Inititial insights from the Irish public service
Empirical study Results
Structure of the Book

2 Implementation Concepts

An introduction to the implementation and organisational change literature
Definition of policy implementation
A landmark study
Top-down approach Bottom-up approach
Synthesis approaches
Summary of implementation approaches
Transformative factors Inferences from the implementation literature
Lines of enquiry put forward for investigation
Common factors
Application of lines of enquiry

3 An Overview of Mental Health Policy in Ireland

Why mental health policy?
The International context for mental health policy
Implementation of A Vision for Change

4 An Analysis of the Implementation of the Mental Health Policy A Vision for Change

Overview of documentary content analysis results
Analysis of interview findings
View of the policy A Vision for Change
Views on the ‘Implementation’ section of the policy
The actual implementation of the policy
What was implemented well?
What was not implemented well?
What is needed to have a modern mental health system?
Examples of policies which have been implemented well
Summary of key findings

5 A Discussion of the Determinants of Implementation

Driving Policy implementation from the top down
Influencing policy implementation from the bottom up
Influencing policy implementation common factors

6 Conclusions

The relative importance of the key determinants of implementation
Relevance to the implementation literature
Limitations of the study and the potential for further research
Final word
Appendix A: Study Methodology
Appendix B: Summary of the Research Proposal Appendix C: Interview Schedule Appendix D: Summary of Content Analysis Findings Bibliography Index

Additional Information

Author Helen Johnston
Publisher Institute of Public Administration
Publication date 28 Sep 2014
Format Paperback
ISBN/EAN 9781904541509

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