Direct payments to support people with mental health needs

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I first came across direct payments in mental health at the turn of the millennium. Remember the fuss about the millennium and how computers would crash and the world wouldn't be the same again? All rather a damp squib, yet personal budgets in mental health, as we now know them, have been gathering strength ever since.

In that early research project I was involved in, the official numbers stated that only 12 people who use mental health services across England were utilising a direct payment to meet their needs. I have to say that I struggled to locate those that were on my patch, but that's another story...

Fast forward to 2014 and figures suggest that there are 31,000 mental health personal budget users with another 2,500 people on a direct payment outside of the personal budget system. So, there has been a substantial growth in usage, but I don't think it's enough.

Having used mental health services myself over many years, I know that the goals of choice and control espoused by our disability colleagues can be difficult terms to realise for people who use mental health services. So I was very excited to conduct some new research with colleagues on what occurs. This was a partnership project between national Mind and The Centre for Citizenship and Community at UCLan http://www.uclan.ac.uk/research/explore/groups/centre_for_citizenship_and_community.php.

Our research was part of a DH funded wider programme of work to improve take up of personal budgets in mental health, and also find out what barriers might still exist. We looked into:

· Thoughts and beliefs about personalisation as a concept and its application for people who use mental health services.

· Knowledge and awareness of Personal Budgets.

· Factors affecting the uptake of Personal Budgets.

· Personal experiences of how Personal Budgets are administered and their effectiveness in enabling people to manage their mental health.

· Key issues for service providers and commissioners and recommendations for practice.

· Priorities for future research on promoting and implementing personalisation and the uptake of Personal Budgets by people who use mental health services.

We interviewed people who use services in receipt of personal budgets, some who didn't even know about them, staff on the frontline, commissioners and providers. These important points are what we found:

· Personalisation as a concept or principle was agreed by all as the right way to go. However, there was a level of caution and doubt with regard to how effectively it was being delivered in practice.

· There are many barriers to the uptake of Personal Budgets which includes knowledge and awareness of them; the application process itself; the relationship between the person who uses the service and the care coordinator and their attitudes towards eligibility; and also how the wider welfare benefits, and health and social care systems work, and the impact of recent reorganisation and other changes within these systems.

· Conversely, factors enabling/increasing the uptake of Personal Budgets included Direct Payment support services; the availability of advocates; support from voluntary sector organisations; and having a good care coordinator.

· The importance of partnership working was stressed by all but, a range of views were provided about the level of existing and need for improved partnership working.

· The majority of participants agreed that if personalisation was to be in place in a way that met the needs of individuals, there would be a reduction in the need for crisis support needing intensive home support or expensive hospital admission. They all agreed that if properly funded, a personalised approach combined with crisis prevention services that were capable of being operationalised at the time of need, would both reduce costs and prevent crisis.

· When participants were asked about how well the system itself worked, a number of problems were identified. People who use services discussed how they found accessing the system and the process involved in receiving a Personal Budget. They also discussed some of the causes for their poor experiences, partly due to the restructuring of services, staff losing their jobs and changes to existing systems. Service providers and commissioners related how well they perceived the system to be working operationally. Critically, views differed as to how effective systems are, and how well quality of services are being measured.

Our end of project event was scuppered by a tube strike, but the reports were launched on the UCLan website at http://clok.uclan.ac.uk/10755/ Please download and read at leisure. Our work adds to a limited body of research in this area, and updates important issues as personal health budgets are being rolled out next year. Overall, what it does is highlight the need for plenty of work to be done in promoting take up in mental health. Also, that choice and control is truly given to people who use services. I and our team intend to be around plugging away at this as it's a job yet to be finished and I'm too impatient to wait for another 14 years gradual progress. The revolution starts now!

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