Health Care Analysis

, Volume 7, Issue 1, pp 57–77

A Systemic and Value-Based Approach to Strategic Reform of the Mental Health System

  • Michael McCubbin
  • David Cohen

DOI: 10.1023/A:1009443902415

Cite this article as:
McCubbin, M. & Cohen, D. Health Care Analysis (1999) 7: 57. doi:10.1023/A:1009443902415


Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us.

epistemologyethicsGeneral System Theorymental healthpolicypolitics

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Michael McCubbin
    • 1
  • David Cohen
    • 2
  1. 1.Visiting Research FellowNational Institute for Public HealthOsloNorway
  2. 2.Ecole de Service social, Groupe de recherche sur les aspects sociaux de la santé et de la prévention (GRASP)Université de MontréalMontréal (Canada