Exploring movement of embodied, enacted, and inscribed knowledge through policy consultation: a case study of a mental health policy consultation process in South Africa.

Abstract

This study is concerned with the intersection of knowledge and policy in the context of mental health system challenges in a developing country. Its focus is specifically on the way in which different forms of knowledge, from multiple sources, move through a policy consultation process to inform mental health policy. Policymakers tasked with developing mental health policies must balance a number of competing demands, including the need to develop policies that are applicable on a national level, while simultaneously addressing the idiosyncratic and contextual particularities associated with mental ill health at individual and local levels. Marrying the principles of evidence-based policymaking, with its focus on what works, with the principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs to incorporate these into policy decisions. In this sense, policymaking represents something of a knowledge problem for policymakers. In the South African legislative context, public participation in policymaking is taken as a given, with little guidance specifying how such processes should be conducted, nor whether or how the inputs from such processes are used in policy decisions. The consultation process around first mental health policy was the focus of this case study. The aim was to trace the movement of knowledge inputs through the consultation summits into policy outputs. Research suggests that certain forms of experiential knowledge may not be amenable to being captured in policy consultation processes. This study thus used a) conceptual schema of knowledge functions in policy as its analytical framework. This schema distinguishes between three phases of knowledge embodied, enacted, and inscribed that can be transformed between phases through various kinds of action. It provided a lens through which to trace the enactment and movement of embodied (experiential and evidence-based) knowledge through the consultation process, to determine the extent to which this form of knowledge was transferred into the inscribed knowledge of consultation recommendations and policy outputs. Data included mental health policy documents, reports and audio recordings from the provincial and national consultation summits, and key informant interviews. Thematic framework and thematic content analyses were conducted using the embodied-enacted-inscribed analytical framework. Findings revealed that no substantive changes were made to the mental health policy following the consultation summits, and suggest that the consultation summits had minimal impact on policy. In particular, there do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs through increasing levels of summarisation during the consultation process. knowledge was not followed through to be incorporated into consultation and policy outputs. The implications of the findings for mental health policy consultation in South Africa are discussed. This is the first study to document, in depth, a significant part of the consultation process around mental health policy in South Africa, using the embodied-enacted-inscribed framework to explore how knowledge inputs informed policy. In doing so, it draws attention to the unique challenges in reconciling the contextual detail of embodied knowledge with the abstract generalisability of inscribed (policy) knowledge an undertaking that has particular relevance for mental health policy consultation. The study highlights the importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces, in order to align assumptions about the value of policy consultation with consultation practice, as well as to strengthen the policy development-consultation implementation link.