Innovations and networks: the case of mental health care reforms in Belgium

This article discusses mental health care reforms in Belgium from an interorganisational perspective. In 2007 a three year experiential government programme was launched seeking for alternative organisation models in mental health care, labeled as 'care circuits' and 'networks'. The target population is 'persons with chronic and complex mental disorders'. This article reports some of the observations based of an ongoing evaluation process. The research evaluates the plan and implementation processes of these collaboration and networking models (the TP). The qualitative approach aims at developing, testing and refining insights in the dynamics of developing collaboration and networks by exploring the complex and dynamic interaction among context, mechanism, and outcome. The article uses insights form health care innovation literature, interorganisational network theories and literature on organisational fields. Health care innovations take place in a complex multi-agent environment. The implementation (adopting and sustaining) of health services innovations is influenced both by 'external' and 'internal' processes and barriers. The public sector context of mental health care includes 'external' influences by multiple stakeholder through values, power plays, regulations and normative frameworks. The development of interprofessional collaboration and interorganisational networks develops thus in an organisational field. An organisational field is complex, heterogeneous, multi-layered and dynamic. Organisations and actors in the field act on the basis of their interests and respond strategically to institutional pressures. Fields also shape the discourse, norms and structures in ways that match their individual interests and objectives. We found plenty of indications in the mental health reform programme. But the research also urges to develop that further insights into the question whether and under what conditions networks and collaborations between different types of organisations actually are effective. The issue of network governance should be elaborated upon.