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Tackling Neglect and Mental Health Reform in a Devolved System of Welfare Governance

Published online by Cambridge University Press:  13 July 2010

JOAN COSTA-FONT ,
LUIS SALVADOR-CARULLA ,
JUAN M. CABASES ,
JORDI ALONSO  and
DAVID McDAID
JOAN COSTA-FONT
Affiliation:
LSE Health and Social Care, Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE email: [email protected].
LUIS SALVADOR-CARULLA
Affiliation:
Department of Psychiatry, University of Cadiz
JUAN M. CABASES
Affiliation:
Department of Economics, Public University of Navarra, Pamplona Navarra
JORDI ALONSO
Affiliation:
Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-Hospital del Mar), Barcelona
DAVID McDAID
Affiliation:
European Observatory on Health Systems and Policies and LSE Health and Social Care, Department of Social Policy, London School of Economics and Political Science
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Abstract

A system of devolved welfare governance, it is argued, increases participation in welfare services. However, limited empirical evidence has been reported on how it influences welfare reform. This paper draws upon evidence from the mental health system in Spain, where health care is devolved to the regional states (autonomous communities), to examine whether policy reform of neglected policy areas may be triggered through heightened policy awareness and better participation of interested stakeholders. We find that regional devolution has helped to scale up mental health in some of Spain's autonomous regions relative to support for other services. Evidence suggests that whilst fragmentation and certain historical legacies remain path dependent, regional devolution has indeed enhanced experimentation, reform and policy innovation in mental health care. However, the expansion of mental health care coverage has been constrained by the lack of a clear definition of public coverage, as well as the need to meet the demands of evidence-based policy in an era of cost-containment. Inequalities in access to mental health care remain; they are compounded by the stigma and discrimination experienced by people with mental health problems, which is a common challenge for all health systems in Europe.

Type
Articles
Information
Journal of Social Policy , Volume 40 , Issue 2 , April 2011 , pp. 295 - 312
Copyright
Copyright © Cambridge University Press 2010

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