A Social work perspective: Personalisation and mental health.
At a time of considerable change to professional roles and organisational structures, where concerns have been expressed about the lack of the distinctive part that social workers have played in the broader provision of health and social services for people with mental health problems; personalisation can and has provided a platform for change. Making personalisation work in mental health services matters because as professionals we know it is those with Mental Health problems that are the most likely to benefit from a personal budget, yet the least likely to get one.
Mental Health is often viewed as one of the more challenging areas for Personalisation, where we as professionals have to challenge ourselves and make no assumptions as to what will or will not work based on an individual's diagnosis and history. One of the challenges for Mental Health Services is moving beyond recognising individuals as the 'patient' and seeing people within their whole social contact as a parent, sibling, carer, employee, employer; it is recognising them within their social context which will strengthen the possibility of recovery (Duffy, 2010). When we talk about recovery we are not talking about recovering from an illness but supporting people to identify and reach their goals. Perhaps it is the strong link between Recovery and Personalisation which sees self-directed support deliver such good outcomes for those with mental health problems.
We have been working this year on a project which aims to increase the numbers of individuals in receipt of a personal budget in mental health services in Leeds. We have been able to reinforce the belief that self-directed support dramatically improves lives of those with even the most complex mental health problems. Where other more 'traditional' services have not worked, self-directed support has offered an exciting opportunity for taking control and having choice to source flexible and responsive support.
Choice is key when talking about 'personalisation', how then do we extend real choice to individuals who experience mental distress? We have piloted the use of an electronic noticeboard in Leeds which enables social workers to develop an advert with the individual which is electronically advertised to providers in Leeds (Leeds Directory 2014). This opens up the market to a broad range of providers including smaller providers and maximises the service user's choice in how their support is delivered. The development of the market is key in being able to offer real choice to individuals. Whilst we acknowledge wider commissioning work is required to address contractual barriers to personalisation, we would like to see the market being nurtured and developed to enable great choice and quality of providers available.
Another key challenge to Personalisation in mental health services is the difficult distinction between 'health' and 'social care' needs; one of which we feel sure the individuals we work with do not (would not) make themselves. We need to work towards true integrated assessment, support planning and review to avoid duplication which is not only expensive but not helpful for the individuals we support. With personal health budgets and possible mixed budgets on the horizon it is imperative we get this right. We need personalised systems that work together to support an individual's wellbeing as one whole entity.
Whilst working on the project the feedback we have received from health and voluntary sector colleagues is the power in sharing individual's stories. When thinking about the future of personalisation this has to be at the forefront of any agenda, and we must maximise opportunities for individuals to share their experiences.
One individual in receipt of a PB tells us,
"My life with Self Directed Support... I can see the light at the end of the tunnel and I'm slowly and carefully reaching out for it and I'm not going to let go... My life after Self Directed Support hopefully... friends, freedom and most of all a future!"...
Another lady explains,
"There has been a seismic shift in how I view myself and what I believe I can achieve".
We hope that the next stage of personalisation sees the development of integrated systems which work together to support individuals and embeds personalisation in health. At this time of organisational and professional change across health and social care we believe personalisation challenges professionals to move away from being seen as the 'expert' and move towards facilitation and empowerment; values which sit firmly within the social work value base. We look forward to seeing a significant development of the market place, 'choice' continuing to be central to the process of self-directed support and true integration between health and social care. Central to all of this is true integrated coproduction with the people who use our services.