Where the wicked problems are: the case of mental health.
OBJECTIVE
To use system ideas and the concept of 'wicked problems' to frame examination of a decade-and-a-half of UK mental health policy.


METHODS
Theoretically informed policy analysis.


RESULTS
Modern health care is complex, and mental health care particularly so. In the UK the mental health system has also become a policymaking priority. Features of this system mean that many of the problems policymakers face are of the 'wicked' variety. Wicked problems are resistant. Problem formulations and their solutions are contestable. Solutions which have 'worked' in one setting may not 'work' in another, and evidence to guide change is open to challenge. Actions trigger waves with widespread system consequences. In the case of the UK's mental health field significant shifts have taken place in formulations of 'the problem' to which actions have been directed. These have included assessments of community care failure, formulations emphasising problems with the professions and, most recently, the need for action to promote mental health and wellbeing.


CONCLUSIONS
In their efforts to secure improvement in a neglected field UK policymakers have unleashed a torrent of top-down actions. Attention needs to be paid to constructing strong, system-wide, partnerships and to examining the cumulative impact of policy actions.
Cardiff School of Nursing and Midwifery Studies, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff CF24 0AB, UK. hanniganb@cardiff.ac.uk
Ben
B
Hannigan
Michael
M
Coffey
D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006291:Health Policy; D006801:Humans; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards; D011050:Policy Making; D006113:United Kingdom