Why is it difficult to promote public mental health? A study of policy implementation at local level

The promotion of public mental health is a challenging endeavour for policy actors and stakeholders. In particular, the implementation of public mental health initiatives highlighted in Standard One of the National Service Framework for Mental Health has been poor and patchy (Department of Health, 2004a). This paper attempts to illuminate the complex process of public mental health policy implementation at local level through the exploration of stakeholders' actions. An exploratory case study design was selected, focusing on one local health and social care community within inner London. A conceptual framework about policy implementation and the concept of partnership working are used to shape the analysis of the empirical findings. This paper addresses the challenges associated with the promotion of public mental health initiatives within one local NHS health and social care community. It attempts to increase the understanding and insights into public mental health policy and practice at local level from a policy implementation standpoint. Using an empirical case study of public mental health in an English locality, some of the key issues explored in this paper are about perceptions of public mental health concepts among key policy actors and also stakeholders' behaviour in Local Implementation team (LIT) partnerships. Furthermore, the authors address the issue of how local policy actors engage the local community in supporting the needs of vulnerable groups such as service users and black and minority ethnic (BME) groups. Although functional par tnership are essential for the promotion of public mental health initiatives, the interdependencies of the stakeholders, competition for resources, power dynamics and the difficulty of engaging a diverse range of voices have a significant limiting effect on achieving successful policy implementation on the ground.