Undergraduate Research Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland.
PLoS One. 2020 Jan 29;15(1):e0228281. doi: 10.1371/journal.pone.0228281. eCollection 2020.
It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions.
The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed.
Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development.
Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.
人们普遍认识到，精神卫生政策的制定应与负责实施政策的人员以及受政策影响的使用者协商。在南非的立法背景下，公众参与决策是被假定的，但对于如何进行协商过程以及如何在政策决策中使用协商意见，几乎没有提供指导。
南非精神卫生政策框架和战略计划于 2013 年在经过广泛协商后通过。本案例研究以 2012 年省级和国家协商峰会为重点，对关键知情人进行了访谈，并进行了文件分析，以探讨协商意见被输入或未被输入以告知该政策的过程。在 2013 年至 2016 年期间进行了七次访谈，并分析了 11 份文件（政策草案和峰会成果）和 23 份国家峰会录音会议的记录。
研究结果表明，在协商峰会后，精神卫生政策没有实质性的变化。似乎没有系统的流程来促进和获取知识投入，也没有在省级和国家层面之间转移这些投入。在最终确定政策之前，也没有就实施的优先事项进行进一步的协商，与会者强调了对地方一级政策实施的担忧。这代表了服务使用者在政策制定中更大程度参与的机会丧失。
与服务使用者代表性不足一起，协商过程的形式限制了参与者之间的互动以及参与或接受更具经验形式的知识的可能性。发现了几个程序要素限制了对协商意见的征求和转移，以将其纳入政策。对未来政策协商的建议包括调整参与性进程的形式，以实现对参与者知识的最佳利用，以及增加服务使用者的参与。
