The Belgian mental health reform: When acombination of soft instruments hampersstructural change

In Europe, the mental health field is undergoing a paradigm shift from a hospital-centered, institutionalized and segmented model toward a community-based, patient-centered and more integrated model. From 2010 onwards, Belgian policymakers availed themselves of new policy instruments to complete this shift, having been hampered by strong professional and cultural barriers over the four previous decades. However, the reform objectives have only partially been achieved.
Assuming that an instrument perspective on policy implementation would illustrate why the reform does not achieve its priority objectives, the article questions the relationship between the types of instruments used and the type of change induced. Drawing on the analysis of three policy implementation processes, we argue that these “soft” instruments are by nature not suitable for initiating any type of change and may have limited effects when used in certain contexts and under certain conditions. The article ends with a discussion of the three limitations of these instruments.