Can we learn from our mistakes? A case study of problems in implementing evidence-based mental health policy

I examined the failure of the UK mental health framework policy NSF-9 to sustain the intended development in Child and Adolescent Mental Health Services (CAMHS) in England from its inception in 2003. NSF-9 used Evidence-Based Policy/Practice (EBP) with Key Performance Indicators (KPIs) derived from both research and expert practitioner advice. Adequate funding was provided, the workforce was engaged from the outset, and the KPIs were supported by dedicated data collection and dissemination systems, so failure was unexpected. I reviewed theories from the social sciences of Public Administration and Policy Research (PAPR) from the perspective of three questions. 1. Are there applicable Public Administration Theories (PATs) that can account for this unexpected outcome? 2. Did the metrics used, or their delivery, have administrative or policy characteristics which undermined their expected impact? 3. Are there organisational factors, separate from EBP commitment, which could have jeopardised the NSF model? I undertook a qualitative synthesis of the findings of several qualitative and quantitative datasets, using constant comparison between the datasets’ results and candidate PATs. I concluded that the currently accepted explanation; NSF-9’s failure was caused by inadequacies in culture and values was incomplete, as they resulted from weaknesses in the EBP model itself. When I applied relevant PATs to the data, it was clear NSF-9 had many faults as a policy within the NHS bureaucracy, which were not compensated within its design, and drove its eventual failure. I concluded that policy success without including evidence from PAPR is extremely uncertain, and is a continuing structural risk, as there is currently a disjunction between PAPR and Health Services Research. This needs urgent correction.