Why are personal budgets not used more in mental health?
Professionals still see risk in people with mental health problems controlling their own support
People with mental health problems use their personal budgets in imaginative ways, such as gym sessions. Photograph: Alamy
People with mental health problems are less likely than other eligible groups to use personal budgets, which give them direct control over selecting and paying for their own support. But when they do have them, the money is spent in imaginative ways. People tend to select things like gym sessions to manage their health, IT to build social networks and sleep-in support to alleviate mental health problems like paranoia. So why has personalisation not really taken off in mental health?
At the National Development Team for Inclusion, where I am chief executive, our analysis of Department of Health documents shows that 80% of personal budget spend is outside the public sector, while 80% of traditional spend is on NHS services. Crucially, people report (through the national POET survey and elsewhere) better mental health as a result of personal budgets.
Personalisation is about far more than budgets. It is about empowering people to find their own solutions by focusing on what they really want from their lives. This fits well with the recovery approach to mental health where people are encouraged to have hope and aspiration for the future. So mental health personalisation policy implementation really should be roaring ahead.
The way forward is clear; four years ago the Department of Health published Paths to Personalisation, spelling out how to make personalisation work for the sector. This detailed resource, created in partnership with people who both use and provide services, has recently been updated and re-published by NDTi and Think Local Act Personal (TLAP).
Our work around the country suggests that the barriers are attitudinal and organisational. Professionals still see risk in people with mental health problems controlling their own support. There is also a belief that the fluctuating nature of many mental health conditions makes it difficult to allocate budgets, though paradoxically it is this fluctuation that makes a personalised approach more appropriate. And a medical model that sees diagnoses and conditions rather than people with strengths and hopes still persists.
In Scotland, the Self-Directed Support Act is addressing these obstacles by focusing on people with mental health problems and initiatives to support them. In England, the way organisations operate appears to be creating barriers. The NHS is the lead agency for mental health across much of the country, usually with NHS Trusts providing adult social care for local councils under partnership arrangements.
Personalisation, which is at the core of care for local government, is not a headline priority for the NHS whose 2014/15 mandate does not even include the word. What does this say about priorities and direction for Clinical Comissioning Groups, NHS Trusts and the social workers they employ? One mental health NHS Trust chief executive told us “All that worries me and my fellow Chief Execs right now is balancing the books and introducing the new payment tariffs”.
Our worry is that alongside this, many local authorities are not engaged with mental health. When explaining the lack of national action from the social care sector, a leading proponent of personalisation stated “local authorities have given up on mental health”. That is not completely true – there are some great local projects in Stockport, Southwark and Hertfordshire, for example. But the picture is generally one of action happening only where a handful of individual social care champions want to make choice and control a reality. Nationally, there is a lack of social care mental health leadership and few commissioning strategies that address personalisation in its full concept beyond the growing (welcome) focus on personal health budgets.
Personalisation is fundamentally about how people can take more control over their services and support so that they can get a real life in their community. Key elements around housing, community engagement and employment are rightly part of the local authority remit. It is unrealistic to expect the NHS to be able to focus effectively on these issues and yet, in many places, local government is not fulfilling its role.
If personalisation (in its widest sense) is to deliver real benefits and outcomes, it is time for a renewed national focus from the social care sector on their role in supporting those with mental health problems.
Credit: The Guardian