Mental Health: Personalisation is about wellbeing and not necessarily services

Personalisation and personal budgets are not going away.

There are three reasons for this. The first is the well documented increase in financial pressure that is affecting Health and Social Care. Many in the statutory sector await the spending review settlement in November with increasing trepidation, but there is also demographic pressure, with ever increasing demand for services, improved survival rates and the expectations of citizens for a decent quality of experience when in contact with the state.

The second reason is that there is good evidence that personal budgets achieve better outcomes than traditional services for each pound spent. For example, the national evaluation of personal health budgets (PHBs) in England which compared the experiences of just over 1000 people who received a PHB to 1000 people who did not (DH 2012).

The third reason is that there are a lot of people now who have personal budgets and personal health budgets who are getting a good deal of value from them as a result of increased flexibility, new choices, and a degree of control that they didn't previously have. People experiencing this greater choice and control over their support are finding it beneficial - it is helping them to achieve better health and social care outcomes (NPBS 2014).

But why are personal budgets and personal health budgets still so poorly implemented in the Mental Health sphere? It is perplexing to think that out of all the groups of people with health and social care needs, the people who can potentially benefit most from the choice and control personal budgets can generate are the group of people persistently most excluded from this opportunity (ADASS 2014).

The reasons why people with Mental Health problems are generally the most unsupported of groups to take up personal budgets and personal health budgets are actually well understood in the sector, but despite this progress seems constrained by cultural issues and a range of practical system problems.

Cultural issues

Within the NHS the social model of disability is simply not as valued as the medical model of disability. The result is that we have an NHS England Taskforce to develop a five-year strategy to improve mental health outcomes that focuses on how 'national bodies will work together...to help people have good Mental Health and make sure that they can access evidence-based treatment rapidly when they need it' (The Five Year Forward View Mental Health Taskforce public engagement findings p.2).

This is fine of course - as far as it goes. But it omits something important - the fact that the so called 'gift model' of state provision is only part of the story of what is needed for health and wellbeing. Wellbeing, and the activities that create it, are not easily provided through traditional services, however well-intentioned or delivered. Wellbeing is subjective and specific to the individual. It is about relationships, communication between people in families, social support, hope, positive attitudes, unpaid peer networks, lifelong learning and community-activity, all of which contribute to 'generalised resistance resources' which combine to create a persistent sense of self across time and contexts - a personal 'sense of coherence' (The Health Foundation April 2015 p.3).

There is ample evidence that a person's sense of wellbeing is a critical factor in recovery from illness in a range of long-term conditions. For example, several longitudinal studies have shown that social networks and social participation appear to act as a protective factor against dementia or cognitive decline over the age of 65. National surveys of psychiatric morbidity in adults aged 16-64 in the UK show that the most significant difference between this group and people without mental ill health problems is social participation, and there is strong evidence that social relationships can also reduce the risk of depression (Fisher 2011).

Much is made of the desire for parity of esteem between physical and mental health, but for this to happen in my view we must also strive for parity of value. We must ensure equality in the value we place on both the social model of disability and the medical model of disability. In an increasingly integrated world, unless we do this we will continue to get some kind of an ill-health treatment service, but as a society we will not see significantly better mental health as a result.

Achieving better mental health across society means finding ways that people can build a spectrum of paid and unpaid support around themselves, rather than picking from a narrow range of service options decided by professionals. The best way to make this wider wellbeing activity happen is by embracing personal budgets and personal health budgets as mainstream mechanisms for increased personalisation - health and wellbeing led by the individual[1].

[1] TLAP have recently launched a new online tool which supports integrated care planning and personal budgets for people with health and social care needs: http://www.thinklocalactpersonal.org.uk/personalised-care-and-support-planning-tool/