Table Of ContentTimothy Philip Fadgen
Mental Health
Public Policy
in Global
Context
A Comparative Study of Policy Transfer
in Samoa and Tonga
Mental Health Public Policy in Global Context
Timothy Philip Fadgen
Mental Health Public Policy
in Global Context
A Comparative Study of Policy Transfer
in Samoa and Tonga
Timothy Philip Fadgen
University of Auckland
Auckland, New Zealand
ISBN 978-981-15-6478-9 ISBN 978-981-15-6479-6 (eBook)
https://doi.org/10.1007/978-981-15-6479-6
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Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Situating the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.2 Why Samoa and Tonga?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.2.1 Population Snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.2.2 Key Economic Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.2.3 Key Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.2.4 Disability and Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.2.5 Cultural Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.6 Government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.7 Health Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.2.8 Section Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.3 The Pacific Research Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.4 Book Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
1.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2 What Constitutes a Mental Health Policy?. . . . . . . . . . . . . . . . . . . . . . 25
2.1 What Is Mental Health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.2 “Institutionalising” Mental Health Systems:
The Government Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3 De-institutionalising Diagnostic Regimes: The Cultural Context . . 34
2.4 Mental Health Policy Development at the ‘Policy Core’:
North America and Western Europe . . . . . . . . . . . . . . . . . . . . . . . . 36
2.5 Mental Health as Human Right . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
2.6 The Global Mental Health Context . . . . . . . . . . . . . . . . . . . . . . . . . 42
2.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3 Can Policy Transfer Help Us Explain the Global Movement
of Mental Health Policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.1 Explaining Policy Migration: Policy Transfer . . . . . . . . . . . . . . . . . 51
3.1.1 Factors Facilitating or Inhibiting Policy Transfer . . . . . . . . 55
v
vi Contents
3.1.2 Determining a Policy Transfer Occurrence
and Evaluating Success or Failure . . . . . . . . . . . . . . . . . . . . 56
3.1.3 The Predominant European and North American
Policy Transfer Research Focus . . . . . . . . . . . . . . . . . . . . . . 57
3.1.4 Other Critiques of Policy Transfer Scholarship . . . . . . . . . . 59
3.2 The Policy Transfer Framework. . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.2.1 Determining the Relevant Scope of Transfer Agents:
IOs and Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3.2.2 Determining What Has Been Transferred . . . . . . . . . . . . . . 65
3.2.3 Transfer Motivations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
3.3 The Constructivist Turn in Policy Transfer Scholarship:
Localisation, Translation and Mimesis . . . . . . . . . . . . . . . . . . . . . . 69
3.3.1 Policy Localisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.3.2 Policy Mimesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
3.3.3 Policy Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
3.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
4 What Constitutes the International Mental Health Policy Context? . 83
4.1 Internationalisation of Mental Health Policy as a Human
Rights Problem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.2 IOs Relevant to Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.2.1 World Health Organization . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.2.2 The World Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
4.3 Regional Organisational Emphasis: The Pacific . . . . . . . . . . . . . . . 89
4.3.1 Pacific Islands Mental Health Network . . . . . . . . . . . . . . . . 90
4.4 Bilateral Aid and Development Agencies: Australian Agency
for International Development (AusAID) and New Zealand
Aid Programme (NZAID) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.5 Constructing the Global Mental Health Context: Relevant
Policy Texts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.5.1 Constructing the International Rights-Based Mental
Health Context: Generic Human Rights Instruments . . . . . 95
4.5.2 The Disability Thematic Shift in Key International
Human Rights Texts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
4.5.3 Establishing Mental Health as Human Right:
The International Context . . . . . . . . . . . . . . . . . . . . . . . . . . 98
4.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
5 How Has Samoa’s Mental Health System Developed Over Time? . . . 111
5.1 Samoa: An Institutional Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 112
5.1.1 Traditional Governance Structures: Fa’aSamoa . . . . . . . . . 113
5.1.2 German Colonial Policies in Samoa . . . . . . . . . . . . . . . . . . 115
5.1.3 New Zealand’s Mandate, Law and Constitution
Making, and an Independent Samoa . . . . . . . . . . . . . . . . . . 116
Contents vii
5.2 Mental Health in Samoa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
5.2.1 Samoa’s Mental Health System: Context Provided
by Historical Legacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
5.2.2 The International Policy Context of Samoa’s Mental
Health Policy Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
5.3 Samoa’s Mental Health Law Development: An Institutional
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
5.3.1 German Colonial Ordinances, Mental Defectives Act
(NZ) 1911 and the Samoa Act (NZ) 1920: Colonialism,
Mandate and Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . 124
5.3.2 Samoa’s Mental Health Ordinance 1961 . . . . . . . . . . . . . . . 125
5.3.3 Mental Health Act 2007: An International Legacy . . . . . . . 127
5.3.4 Bringing the Bill Forward: Parliament and the Mental
Health Act 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
5.4 Samoa’s Mental Health Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
5.4.1 Samoa’s Mental Health Symposium . . . . . . . . . . . . . . . . . . 132
5.4.2 Policy Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
5.4.3 Community Consultation of Policy . . . . . . . . . . . . . . . . . . . 136
5.5 Practice-Level Change: The Indigenous Professional as Agent
of Informal Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
5.5.1 Professional Networks as Source of Best Practices
in Service Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
5.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
6 How Has Mental Health Policy and Praxis Been Indigenized
in Tonga? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
6.1 The Infamous Case of R v Priven . . . . . . . . . . . . . . . . . . . . . . . . . . 148
6.2 Institutional Overview: Indigenous and Introduced . . . . . . . . . . . . . 149
6.2.1 Tonga as British Protectorate . . . . . . . . . . . . . . . . . . . . . . . . 151
6.2.2 Traditional and Introduced Governance Structures . . . . . . . 153
6.2.3 Governance: Enduring International Role as Legacy
of British Protectorate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
6.3 Tonga’s Mental Health System History and Overview . . . . . . . . . . 155
6.4 International and Regional Organisational Influences
on Mental Health System Reform . . . . . . . . . . . . . . . . . . . . . . . . . . 159
6.5 Mental Health in Tonga: Perceptions of Homelessness,
Domestic Violence and Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
6.6 Tonga’s Civil Society and the Mental Health System: Domestic
Violence, Suicide Prevention and Disability Associations . . . . . . . 163
6.7 Tonga’s Mental Health Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
6.8 The Absence of a Mental Health Policy and Public
Education Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
6.9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
viii Contents
7 What Insights Can Be Gained from Mental Health Policy
Change in Samoa and Tonga? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
7.1 Defining and Locating Mental Health in Samoa and Tonga . . . . . . 177
7.1.1 Identification of Mental Health and Illness as Socially
Situated Phenomenon: Common Themes . . . . . . . . . . . . . . 177
7.2 Three Levels of Policy Change: Formal, Quasi-Formal
and Informal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
7.2.1 Formal and Quasi-Formal Policy Transfer . . . . . . . . . . . . . . 181
7.2.2 Informal Policy Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
7.3 Transfer Agents: International and Bilateral Organisations
and Indigenous Policy Entrepreneurs . . . . . . . . . . . . . . . . . . . . . . . 192
7.3.1 International and Bilateral Organisations . . . . . . . . . . . . . . 192
7.3.2 Indigenous Professionals and Informal Policy Transfer . . . 194
7.4 Conditions Peculiar to Samoa: Framing the ‘Samoan Context’ . . . 199
7.5 Factors Peculiar to Tonga: Political Instability During Health
Sector Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
7.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
8 Postscript . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Appendix 1: Timeline of Key UN General Assembly Measures,
WHO Initiatives and International Conventions
related to Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
List of Common Abbreviations
ABS Australian Bureau of Statistics
ADB Asian Development Bank
AGS Archives of German Samoa
AusAID Australian Agency for International Development
CRC Convention on the Rights of the Child
CRPD-OP C onvention on the Rights of Persons with Disabilities
& Optional Protocol
DALY Disability Adjusted Life Year
DSM Diagnostic and Statistical Manual of Mental Disorders
IBHR International Bill of Human Rights
IGO Intergovernmental Organisation
IO International Organisation
JICA Japan International Cooperation Agency
LAMIC Low and Middle Income Country
LDC Less Developed Countries
NCD Non-communicable Disease
NGO Non-governmental Organisation
NZAID New Zealand Agency for International Development
PICs Pacific Island Countries
PIMHnet Pacific Island Mental Health Network
SBS Samoa Bureau of Statistics
SLARD-MHB S amoa Legislative Assembly Record of Debate on Metal
Health Bill
SMoH Samoa Ministry of Health
SNHS Samoa National Health Service
SNZ Statistics New Zealand
SPDR Samoa Parliamentary Debate Record
SUNGO Samoa Umbrella of Non-Government Organisations
TMoH Tonga Ministry of Health
TTMH Tupua Tamasese Meaole Hospital
UN United Nations
ix
x List of Common Abbreviations
UNDP United Nations Development Program
UNFPA United Nations Population Fund
UNICEF United Nations International Children’s Fund
USAID United States Agency for International Development
VHPF Victorian Health Promotion Foundation
WB World Bank
WHO World Health Organization
WHO-WPR World Health Organization, Western Pacific Region
WTO World Trade Organization
