Mental Health Commissions of Different Sub‐species: can they effectively propagate mental health service reform? Provisional taxonomy and trajectories

The aim is to provide a brief overview of a series of articles tracing the emergence of several Mental Health Commissions (MHCs) in developed countries over recent years, sometimes to enhance mental health law administration, but often in connection with mental health reform strategies. The paper seeks to review the functions of, and elicit a framework for, Mental Health Commissions (MHCs) as effective vehicles for effective operation and reform of a mental health service system.

The approach of the paper is to identify the functions and limitations of Mental Health Commissions and then cluster them to form a typology of commissions.

There are broadly three types of MHCs: the first is more inspectorial and focussed on issues, concerns and complaints affecting the care of individuals, and is more restricted investigating the mental health service and the workings of mental health laws mainly to these ends; the second type is focussed on the entire mental health service system, including relevant all‐of‐government operations, concentrating on monitoring for and promoting system‐wide reform. While this appears to constitute a spectrum, with different MHCs mandated to work mainly at either end of it, there is conceivably a third type which has a combination of these functions. This occurs with some commissions, though an equal balance between these functions is unusual, so they usually can be assigned to a type on the basis of their predominant functions.

There was a limited sample size, obliging a non‐statistical descriptive analysis which may well affect the validity of these distinctions.

There is sometimes a combination of functions encompassing some features of both of these types. While type I MHCs can ensure that individual rights are upheld and that mental health laws and regulations are adhered to, to improve service quality, type II MHCs are likely to be more effective in achieving system‐wide mental health service reform.

MHCs can contribute to more holistic, evidence‐based and recovery‐oriented service delivery, which are more likely to lead to more desirable health and wellbeing outcomes for all mental health service users, their families and the community.

This typology provides a useful provisional framework for understanding the roles of MHCs in mental health services and in reform of the whole mental health service system and related systems.