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.
Comments
Posted on by Michael Sheppard
Siobhan, this is great work and matches my own experience in Warrington that personalised budgets for people with mental health needs are the last rather than the first thought.
Just embarking on attempting to personalise a supported housing service for 57 people in Warrington who are currently supported by us under a block contract arrangement. As the provider we are taking the initiative on this and if we hadn't, the contract would just have been retendered as normal at the end of its term without the 57 individuals having any choice or control in the process.
Instead we hope that personalisation will move them from being passive recipients to active commissioners in their own support, leading hopefully to some very different outcomes in their lives.
Good to know we are not alone.
Michael Sheppard, Warrington Community Living
Posted on by Old Site User
A really great read. I have been working on a personalisation project, Nucleus, for the past 2 ½ years at Brent Mind. Nucleus was born out of the concern that the generic Advice, Information and Guidance service model, whilst recovery driven, did not fully embrace the concept of self directed support. When we launched in 2012, the implementation of personalisation was, to put it mildly, chaotic. Knowing that, even if it was functioning at all, we would be very restricted to those people who were FACs eligible, i.e. assessed as having frequent and substantial needs. To cut a very long story short, we adopted a model whereby we would work with anybody – diagnosis or not, FACs eligible or not, and help them produce action plans and move forwards in their lives – choice and control the key principles.
We are very proud of what we have achieved but remain disappointed that so many agencies right up to government have adopted the attitude towards personalisation in mental health of “lets go so far, but not all the way”. Personal budgets!!! Whilst in Brent we have come along way – remember I said in 2012 it was chaotic? – we now have a panel that sits every two weeks and personal budgets are going through. Great efforts and strides have been made. For us, though, it is still all too restrictive, as highlighted by Rob and Naomi yesterday at their workshop. We are bound by policy and sadly for Nucleus, when our funding ends in November this year, things will not move forward as quickly as we had hoped or, perhaps naively, had anticipated.
Anyway, enough of the doom and gloom, like I say we have made massive strides and our outcomes exceed all expectation. 280 people to date have fully engaged in brokerage with 247 (88.3%) reporting improvements in at least 3 points of the Recovery Star. Over 28 people volunteer through Nucleus, whilst we have referred over 150 people, on their request, to over 200 NHS Recovery College workshops. Over 30 have gained full time employment (16 hours or more) and 10 have retained work. Over 80 organisations in Brent have worked with us and used the brokerage model, whilst joint working with Health and Social Service agencies has produced new initiatives along with enhancing structures. We are delighted.
Perhaps we can discuss our work and share ideas?
Posted on by Old Site User
Really important work going on here and as those concerned continue to push forward and break down the barriers to enabling people using mental health services to be able to access
personal budgets, it will become increasingly important to encourage everyone to think as creatively as possible. Siobhan has written that recovery is about 'supporting people to identify and reach their goals' and the importance of choice and opening up the market. I would suggest that coaching is a new area of support strongly worth considering for people with mental health needs and ( and other needs), using personal budgets as the coaching model completely resonates with choice and control, goal identification and clarification,designing and planning the small steps needed on the journey towards the goal and supporting and motivating people to achieve their ultimate goal.
I make my comment from the position of someone who a few years ago was in a regional role steering personalisation and taking an early lead in highlighting the issues of lack of PB uptake within mental health services and now having changed career to a professional coach, can really see the benefits gained when people have access to support which helps them to develop increased confidence and self-belief and a clear goal with actions to work towards.
Posted on by Old Site User
" If we are to sign up to the vision of Recovery Assisting Systems, we can only do so from a holistic veiw of the person,with the person. We can no longer look at people in terms of their symptomology, tick boxes and measured outcomes on a sliding scale, and continue to "do to" in isolation from that which really matters and makes sense to the person. That's the shift. That's the challenge". Rowland Urey chair CLEO.
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