Personalisation in mental health - getting it right means asking ourselves the right questions

Question: What does a personalised mental health service look like?

By virtue of its definition, personalisation can and should look different in almost every case. Everyone is different and so the support they receive should reflect this. There is no blueprint that can be used across sites or scenarios. We are used to being encouraged to share good practice and apply what we learn from others in our own work, but this doesn't easily solve the conundrum of ensuring people are in the driving seat of their own recovery. And we should never assume we are going about supporting people in the right way - we can only base a judgement on evidence and thorough self-scrutiny.

So how can we really know when we've got it right? For a start, we can reframe the question to focus more on the experience of the individual than the service they use:

How do we know when someone's support is truly personalised?

The language of personalisation is tricky. Besides the fact it's something you might most commonly do to a number plate or a mug, the difference between personalised and person-centred support (or self-directed support, or a whole-person approach...) is difficult to define - if there's a difference at all.

The social care world is confusing to most people - not least those in need of its support - often due to its impenetrable vocabulary. When an approach or idea gains in popularity, people are keen to be able to say they are applying it. This emphasis on telling instead of showing usually just leads to more and more words and less substance. Using an evidenced-based approach where we capture feedback directly from those using the service is one way of guarding against any potential tokenism.

So, time spent trying to pin down definitions is probably time spent solving the wrong problem. Let's go back to basics. Let's talk about people having choice and control. And that doesn't mean a care coordinator, GP or family member determining when someone has choice and control. That's the individual saying first hand that they have choice and control over the things in their life that matter most to them.

Which means we can reframe the question again:

What does it mean when someone has choice and control over their mental health support?

The obvious way to find out is to ask. But knowing how to ask and how to interpret the answer is less straightforward.

For many people who've been using services for a long time, having choice and control may not be what they're used to and it can seem scary and uncomfortable. They may resist it to start with. They may struggle to set meaningful goals, or understand what changes are important to them in their life. The support they've had in the past may have kept them dependent rather than moving them forward.

People are hurting from so much change happening around them - changes to their benefits, their housing and their social care. This has to be taken into account when transforming services and teams around them. Ensuring people are leading their own support requires long and sustained investment of resources to get right. It's important to start moving forward even if it may take multiple attempts to get it absolutely right.

One thing we've found is that people with lived experience of mental distress can provide excellent support to others, but to get this right takes planning and investment. Peer Supporters are indispensable to personalised services, perhaps because they have made a choice to use their own experience of mental distress to support their peers in an equal and reciprocal relationship. There are no forms or performance indicators to distract them from the goals of the person they are supporting.

The challenges that come with personalisation may be more pronounced in the context of mental health than elsewhere. People have ups and downs. They may come in and out of contact with the support networks around them. But by empowering people, by focusing on their rights as citizens, and by remembering that their own experience of the support they get is the ultimate test in how a service is performing, we can deliver great and significant results.

Together has just come to the end of a three-year evaluation of Your Way, a model of personalised community mental health support established by us. Working alongside the Mental Health Foundation, we set out to assess the impact of Your Way services on people's wellbeing, goal attainment and indicators relating to quality of life. By focusing on what success looks like to the individual we're supporting and using this as the basis for measuring our performance, we can assess how we are doing without losing sight of the principles of personalisation.

By staying true to our values, keeping choice and control at the forefront of everything we do, and always remembering who this is about, we can stay on track. It's easy for providers to get caught up with being accountable to our commissioner, to our funding body, to the Care Quality Commission (CQC), to the Community Mental Health Teams (CMHT) to our trustees. Or even to ourselves and the targets we set for the team last month.

Really, there's only one person we're accountable to, and that's the person in front of us looking for support.