Department of Occupational Sciences & Occupational Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
Leadership Team, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
BMJ Open. 2023 Feb 1;13(2):e063994. doi: 10.1136/bmjopen-2022-063994.
Mental health services continues to be a high priority for healthcare and social service systems. Funding structures within community mental health settings have shown to impact service providers' behaviour and practices. Additionally, stakeholder engagement is suggested as an important mechanism to achieving the intended goals. However, the literature on community mental health funding reform and associated outcomes is inconsistent and there are no consistent best practices for stakeholder engagement in such efforts.
This study sought to understand how stakeholder engagement impacts outcomes when there is a change in public funding within community mental health settings.
A realist synthesis approach was used to address the research question to fully understand the role of stakeholder engagement as a mechanism in achieving outcomes (system and service user) in the context of community mental health service reform. An iterative process was used to identify programme theories and context-mechanism-outcome configurations within the literature.
Findings highlight that in the absence of stakeholder engagement, funding changes may lead to negative outcomes. When stakeholders were engaged in some form, funding changes were more often associated with positive outcomes. Stakeholder engagement is multifaceted and requires considerable time and investment to support achieving intended outcomes when funding changes are implemented.
To support successful transformation of community mental health programmes, it is important that stakeholders are meaningfully engaged during funding allocation changes. Stakeholder engagement may entail connecting around a shared purpose, individual participation and meaningful interactions and dialogue.
心理健康服务仍然是医疗和社会服务系统的重中之重。社区心理健康环境中的资金结构已被证明会影响服务提供者的行为和做法。此外，利益相关者的参与被认为是实现预期目标的重要机制。然而，关于社区心理健康资金改革和相关结果的文献并不一致，也没有关于在这种努力中利益相关者参与的一致最佳实践。
本研究旨在了解当社区心理健康环境中的公共资金发生变化时，利益相关者的参与如何影响结果。
采用现实主义综合方法来解决研究问题，以充分了解利益相关者参与作为实现社区心理健康服务改革背景下系统和服务使用者结果的机制的作用。在文献中，采用迭代过程来确定方案理论和情境-机制-结果配置。
研究结果表明，在没有利益相关者参与的情况下，资金变化可能导致负面结果。当以某种形式让利益相关者参与时，资金变化往往与积极的结果相关。利益相关者的参与是多方面的，需要大量的时间和投资来支持实现预期的结果，当资金变化得到实施时。
为了支持社区心理健康计划的成功转型，在资金分配变化期间让利益相关者有意义地参与是很重要的。利益相关者的参与可能需要围绕共同目标、个人参与和有意义的互动和对话来进行。
