مدیریت عمومی(جدید) مجرمین مبتلا به اختلال ذهنی: قسمت دوم:یک چشم انداز با وعده

Integration policy has failed because it is not cost-effective from the perspective of the different systems. Working together requires investment both in the innovation aspect of change and in the process of change itself. That is, building cross-system and intraservice partnerships requires investment in innovation—the development of new service entities and new management. It also requires investment in the process of negotiating the change; these costs are often overlooked and undervalued. Neither the funding nor the motivation for innovation is likely to be forthcoming from resource-strapped public systems; nor does it make sense to expect innovation from large, monolithic systems that are entrenched in tradition. The challenge of modernising is to think outside the box and invest in structures and processes that will perform in desired ways and produce preferred outcomes.

Integration policy has failed because it is not cost-effective from the perspective of the different systems. Working together requires investment both in the innovation aspect of change and in the process of change itself. That is, building cross-system and intraservice partnerships requires investment in innovation—the development of new service entities and new management. It also requires investment in the process of negotiating the change; these costs are often overlooked and undervalued. Neither the funding nor the motivation for innovation is likely to be forthcoming from resource-strapped public systems; nor does it make sense to expect innovation from large, monolithic systems that are entrenched in tradition. The challenge of modernising is to think outside the box and invest in structures and processes that will perform in desired ways and produce preferred outcomes. This article is the second in a two-part series on integrating the systems and services used by mentally disordered offenders. Part I described the incremental integration approaches implemented by the British government in recent years, and explores why these approaches have been and are likely to be ineffective. Herein, I present, in Section 2, an alternative integration strategy; one that strives to maximise integration potential and minimise implementation costs through a ‘single ownership’ model of systems and services integration. In Section 3, limitations of the holistic approach are discussed. The article closes with a call for the adoption of holistic integration policies that are likely to work and the rejection of incremental approaches that have not worked in the past and are not likely to work in the future.

Building a better, more productive system of care begins with creating a financing scheme that encourages integration. Unifying funding streams in a single ownership entity that has a clear and comprehensive trustee mandate is the most promising organisational model. With this new entity in place, problems of systems and services dysfunction would be less intractable and daunting, as solutions to structural and procedural impediments could be efficiently and effectively managed with appropriate financial incentives and performance monitoring. Furthermore, unifying diverse functions under common leadership offers the advantage of infusing a culture of collective responsibility, a notion that each is ‘not responsible for a piece but for the whole’ (Drucker, Kanter, & Graham, 1994). Collective responsibility for those who are the least advantaged and for whom the system and service boundaries are the thickest, and the clinical and social risks the highest offers the greatest hope for achieving the promise of the community care model and the outcomes valued by individuals with mental illness and the society in which they live.