The systems I use support me to make my own decisions. People listen to me and treat me with respect.
What helps to make this happen?
From the very first contact - by phone, on line, personal visit, or meeting - the messages that individuals or their friends or family members receive will have an impact on the way they feel about themselves and on the way they engage with organisations and professionals. A personalised approach will be evident in the language, attitudes and behaviour on initial contact and in all the processes that people go through. The simple test for this is to ask ‘How would I feel if this was what I, or a member of my family, experienced?'
Person centred approaches were promoted through Valuing People (DH, 2001) for people with learning disabilities. The guidance produced to support the development of person centred approaches defines the term as: ‘activities which are based upon what is important to a person from their own perspective and which contribute to their full inclusion in society. ....Person centred planning is a process for continual listening and learning, focussing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends.' (DH, 2001)
Putting People First highlights the intention for these approaches to be used across the board and for ‘Person centred planning and self directed support to become mainstream..'
I have a good experience when I first seek information, help or support.
I am treated in a respectful way that leads to the right outcomes for me
People have a sense of being respected if they experience:
• A recovery approach that treats people as equal partners with the hope and expectation of a fulfilled life
• Assessment and self-assessment that is a set of personalisation principles, not just a document, and takes account of varied experiences, backgrounds and complexity of need
• Assessment that focuses on what matters to people and what works or does not work for them
• Co-production as the everyday approach: this means people working in partnership with their family, carers and professionals to plan, develop, arrange or purchase the services and support that are appropriate to them
• Person centred planning and reviews that put people in control and equip and empower them to make decisions about their own support and recovery
• People who genuinely listen and go at a pace that suits the person they are supporting: this will be reflected in outcomes and how close they are to what people want for themselves
• An integrated system that responds to people's diverse roles and needs (e.g. health, family, parenting, relationships, housing, employment, leisure, education) and does not only focus on times when people are unwell (For more detail see Partnership Section)
• The right and appropriate support to help people be prepared and ready to take control and to plan for their own recovery
People I come into contact with have the right approach and skills to treat me respectfully, help me recover and live my life the way I choose to Examples of what needs to be in place to support this:
• A culture that systematically promotes and nurtures the right approaches and skills - with all new staff routinely inducted into person-centred approaches and person centred thinking
• Senior management commitment and enthusiasm to get the culture right
• Clarity about resources for training in person-centred systems, approaches and person centred thinking (including for senior managers) and for developing good information and communications
• Learning and problem solving encouraged and built in to systems
• Clear local and government support for innovation and creative use of processes, practice and resources - so that staff are confident that this is a recognised and endorsed way of working (See also Workforce and Organisation Development)
There is a planned and balanced approach to crisis and risk that I feel confident in and that does not undermine my sense of being in control of my life and recovery
Getting the balance right between creativity, personal control, aspiration and positive risk management is a key challenge to address for personalisation. Risk is something we all live with every day and is an important part of opportunity and change but responses to this in services can sometimes result in over-restrictive practices. On the other hand, significant risk, for example of self-harm or harm to others, needs to be acknowledged and worked with in a responsible way.
Although the IBSEN evaluation 5 of the Individual Budget Pilots did not demonstrate any increased risk to or by people using individual budgets, it did report concerns raised by care, social work and adult safeguarding staff around ‘the possible risks of financial abuse, neglect and physical harm'. Balanced against this is the evidence of people with mental health needs using individual budgets reporting ‘a higher quality of life and a possible tendency towards better psychological wellbeing' (SCIE, March 2009) and evidence from international research that 'people using self-directed support instead of traditional services are generally more likely to report improved outcomes and satisfaction' (SCIE, March 2009)
Examples of things that will help achieve this balance:
• Advance directive and crisis planning and day to day person-centred risk management that is taken seriously - so that people are confident that action will be taken with due regard to their plans and wishes
• Recognition that people's needs are not constant and any risk agreements should be regularly reviewed and subject to change
• Activity that promotes a positive risk taking culture in organisations, for example: involving people in developing a Choice, Empowerment and Risk policy, training for all, and support from senior managers so that staff feel confident about this approach
• Self-regulation, with investment in resources to offer peer support and share feedback about, for example, people's experiences of providers and personal assistants
• Involvement of people in setting up and carrying out quality assurance activities
• Sufficient time spent with people to help them design support that will be based on their choices and wishes, whilst recognising those risks that can be reduced
• Acknowledgement of carers needs and wishes and the sensitive balance of support for the rights of all involved
SIGNPOSTS
Care Programme Approach and Assessment
1. Wellness Recovery and Action Plan, A practical approach to recovery http://www.workingtogetherforrecovery.co.uk/Documents/Wellness%20Recovery%20Action%20Plan.pdf
2. 3 Keys to a Shared Approach in mental health assessment, CSIP/NIMHE, 2008 http://www.3keys.org.uk/
3. Re-focusing the Care Programme Approach: Policy and Positive Practice Guidance , DH, March 2008 www.dh.gov.uk/publications
4. Effective Care Co-ordination in Mental Health services: Modernising the CPA: A policy booklet (DH, 2000) www.dh.gov.uk/publications
Positive Risk Taking and Risk Management
5. DH, Independence, Choice and risk: a guide to best practice in supported decision making DH, 2007 Best practice guide, learning and development materials, supported decision making tool, leaflet for people using services http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074773
6. Person centred risk A course for senior managers, first line managers, family members and carers and support workers. http://www.helensandersonassociates.co.uk
7. Risk enablement and personalisation project. DH Social Inclusion Programme info@tonyryan.org
8. Positive Risk Taking Policy: Gateshead Council's Community Based Services An example of a policy that has been developed to ensure that there is a consistent approach to the identification, assessment and management of risk across services http://www.scie-socialcareonline.org.uk/profile.asp?guid=4225c224-60eb-48fe-837b-c6c44172cb80
9. Clinical Risk Management: A clinical and practitioner manual, Steve Morgan, Sainsbury Centre for Mental Health, 200 http://www.scmh.org.uk/pdfs/clinical_risk_management.pdf
Person-centred approaches
10. Person-centred thinking with people who use mental health services, Helen Sanderson Associates with David Coyle, University of Chester (2005) www.helensandersonassociates.co.uk/PDFs/MHminibookweb.pdf
11. Our choices in mental health, CSIP A framework for providers to extend choices and practical support http://www.mhchoice.csip.org.uk
12. Supporting People with Long Term Conditions (Re: Statement of values and principles of care planning. P12) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100252
13. Co-production: an emerging evidence base for adult social care transformation: SCIE Research Briefing 31,2009 http://www.scie.org.uk/publications/briefings/briefing31/index.asp
14. Website with support planning resources http://www.supportplanning.org/MentalHealth/
