Remodelling services for new contexts : responding to community mental health need in Malta

Abstract

‘Active Remodelling for Congruence’ (ARC) has been developed by this author as an approach to systematically adapt exogenous models and policies to the context of an adopting country. Models are not imported whole, but analysed into components. The separate adaptability of each component is examined with respect to characteristics of the receiving context. Simultaneously, a context-congruent service framework is derived and proposed for the delivery of community mental health services in Malta. ARC is used to adapt models from overseas, especially UK. ARC is thus tested out and refined. Congruence on the services level is sought with four other levels, each of which is therefore first appraised. The Maltese country context is portrayed through history, cultural expectations, comparative welfare and the progress of public policy and management. The user world is examined through questionnaire interviews designed by leading researchers into community mental health needs, met and unmet, family impact of illness and quality of life. Prevailing and desirable values are identified and applied. Recommendations for service are then made, congruent also with the organisation level, or local management capability. Rather than reactively fitting with them, congruence creatively questions contexts too, appealing to values. Relatively weak Maltese resources and capability contrast with strong - though surprisingly undeveloped - potential in family and civil society. A flexible case management is recommended that can 'change gear’ into less or more resource intensive alternative models. This prudently limits assumed responsibility and cost, sharing them with civil society, and invests in managerially supported targeting, streaming, prioritising, minimising bureaucracy and promoting independence. Relevant issues are thus identified, preparing ARC for use in other country contexts. Finally, bridges are suggested to contemporary readers between intellectual disciplines, cultures and 'epochs’ (namely, post-modernity, modernity and pre-modernity) hoping that such research can be viewed with less fragmented and less unsure minds.