<abstract xmlns="http://www.w3.org/1999/xhtml">This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient care and expanding community mental health systems, on policy and programmatic decision making. A central focus of the study involves the trade-offs between and efforts to integrate shared decision making with evidence-based planning methods within the context of a national psychiatric reform strategy, particularly one involving a former Soviet bloc state.Given the uniqueness of the Czech experience, an exploratory case study methodology is used, one involving ten interviews with key informants and examination of a wide variety of documents. Results include the development of broad new decision and oversight structures, and the initial implementation of community mental health services. The nation faces some of the same trade-offs found elsewhere, such as in the United States, between an inclusive participatory process, and one that systematically incorporates empirical rational and evidence and best practices within bounded parameters.Implications for new psychiatric deinstitutionalization initiatives are identified, including development of a national mental health authority, a professional workforce, new funding strategies, multi-level service coordination, mechanisms to assure transparency, among others.</abstract>

This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient care and expanding community mental health systems, on policy and programmatic decision making. A central focus of the study involves the trade-offs between and efforts to integrate shared decision making with evidence-based planning methods within the context of a national psychiatric reform strategy, particularly one involving a former Soviet bloc state.Given the uniqueness of the Czech experience, an exploratory case study methodology is used, one involving ten interviews with key informants and examination of a wide variety of documents. Results include the development of broad new decision and oversight structures, and the initial implementation of community mental health services. The nation faces some of the same trade-offs found elsewhere, such as in the United States, between an inclusive participatory process, and one that systematically incorporates empirical rational and evidence and best practices within bounded parameters.Implications for new psychiatric deinstitutionalization initiatives are identified, including development of a national mental health authority, a professional workforce, new funding strategies, multi-level service coordination, mechanisms to assure transparency, among others.

Decision Making in Psychiatric Reform: A Case Study of the Czech Experience

Central European Journal of Public Policy

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Decision Making in Psychiatric Reform: A Case Study of the Czech Experience"}

This study examines the initial impact of a broadly participatory planning process in the Czech Republic during 2016–2017, aimed at both reducing inpatient...

Dimension & Indicator	Period		Change

	Pre-Reform Level	During Reform
I. Community Participation
Patient and ex-patient	1	2	+
Families of patients	1	2	+
Community providers	2	3	+
Other	1	2	+
II. Rationalization of decision making
Assessment of needs	1	1	0
System planning and management	2	3	+
Policy/programme evaluation	1	2	0
III. Type of Decision Making	Incremental-Disjointed	Bounded Rationality

Decision Making in Psychiatric Reform: A Case Study of the Czech Experience

Published Online: Nov 12, 2019

Page range: 15 - 27

Received: Apr 14, 2019

Accepted: Jul 31, 2019

DOI: https://doi.org/10.2478/cejpp-2019-0007

Keywords
Psychiatric reform, psychiatric deinstitutionalization, community mental health, participatory decision making, policy development, bounded rationality

© 2019 Christopher G. Hudson et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Fig. 1

Decision Making in Czech Psychiatric Reform: Summary of Major Patterns and Changes

Decision Making in Psychiatric Reform: A Case Study of the Czech Experience

Published Online: Nov 12, 2019

Page range: 15 - 27

Received: Apr 14, 2019

Accepted: Jul 31, 2019

DOI: https://doi.org/10.2478/cejpp-2019-0007

KeywordsPsychiatric reform, psychiatric deinstitutionalization, community mental health, participatory decision making, policy development, bounded rationality

© 2019 Christopher G. Hudson et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Fig. 1

Decision Making in Czech Psychiatric Reform: Summary of Major Patterns and Changes

Keywords
Psychiatric reform, psychiatric deinstitutionalization, community mental health, participatory decision making, policy development, bounded rationality