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There is growing evidence that mental health policy is failing. One reason for this may be that the top‐down approach of governments and transnational agencies is unable to engage the grassroots successfully: in particular, users and ex‐users of mental health services. Failure to work in partnership with the grassroots begets policy failure when translated to the local level. Robert Hayward and Paul Cutler explain why international bodies like the UN, the international development banks and the World Health Organization (WHO) have been hugely influential but not necessarily successful in achieving improved outcomes for disadvantaged people, notably in countries in transition.

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