ABSTRACT

This chapter will make some reflections on different types of influences and evidence that have had an impact on changes in mental health policy in Sweden. It will focus on some factors of importance for the transformation of services toward community-based services as well as changes in the content of services on an intervention level. This task is complicated by the fact that a number of types of evidence and other influences are simultaneously affecting mental health policy in a way which makes it hard to distinguish their specific contribution. Broadly, we might find three hypothetical sources of influences. The first is concerned with the implementation of scientific evidence of efficacy and effectiveness, manifested in the movements of evidence-based medicine and evidence-based care. The second, less clear-cut group of influences stem from what may be labelled ‘clinical evidence’, which includes the history of personal or local experiences of treating people with mental illness, although not systematically analysed. The third group of factors, which have been growing in importance, are related primarily to ethical or humanitarian views or ideologies of different stakeholders in psychiatric services. Obviously, the development of the user movements is of great importance in this context. However, these influences might be different or vary in strength depending on whether we look at the patient intervention level, local service level or national level. A fourth factor is that these influences also probably differ in importance depending on what aspect of treatment or mental health policy we are looking at.