‘Personalisation? I know this is
happening when I am treated with warmth, respect and honesty - when people
listen to me, treat me as an equal, and support me - and when I don't have to
fight all the time to get what I want to help me recover and live my life the
way I choose to' Mental health expert by experience
There has been a gathering policy momentum
leading to local authority and health service reform. A fundamental re-think of
the relationship between citizens and public services runs through, for
example, Improving the Life Chances of
Disabled People, Our Health, Our Care, Our Say, Putting People First, and NHS Next Stage Review.
The main messages
are very clear. We should expect a
personalised approach, which means a relationship with public services which ensures
that:
- We are empowered to have more say and control in all aspects of public life and participate as active and equal citizens
- We have maximum control of our own lives, including control of our own health and health care
- We are supported to live independently, stay healthy and recover quickly
- We have choice and control so that any support we may need fits the way we wish to live our lives
One way of giving
us more control over the support we may need is to allocate an amount of money
( a personal or individual budget or direct payment) so that we can decide ourselves
how it can best be used. Having access to personal budgets has undoubtedly led
to very positive outcomes for some people. An Individual Budgets Pilot
Programme (IBSEN) took place in England in 13 local authorities and has now
been evaluated. The evaluation report found that having an individual budget was associated
with better outcomes and higher perceived levels of control and people had more
positive aspirations for their lives. Specific benefits for people with mental
health needs were reported. However, the report also highlighted major barriers
to take up for people with mental health needs. Research on Direct Payments also shows that they are least
commonly provided to people with mental health needs
Direct payments for people with mental health
problems: A guide to action sets out good practice in making direct
payments more accessible to people with mental health needs. This guide follows on and places
personal budgets in a wider context.
Introduction
Money by itself
does not guarantee choice or control.
It is clear that if opportunities are to be more generally available to
people with mental health needs and not just a battle won here and there (relying
on good luck and a few right thinking people) there need to be radical changes
that will place personal budgets in the wider context of personalisation.
Personalisation
means recognising and respecting us as individual
citizens, family members and members of our community with the informal networks
that provide most of our support, most of the time. It cannot be achieved
without an energetic and effective partnership approach between and beyond
health and social care. It requires partnership that concerns itself with
improving the life and health of all citizens, and removing barriers so that
there is access for all to activities, services and opportunities. This is an
approach requiring comprehensive cultural and organisational changes to
encourage creativity, innovation, positive risk taking and to change the
balance of power between citizens and public services. The IBSEN evaluation
reported cultural and organisational barriers in these areas, particularly in
mental health, that will need to be addressed to make any real impact on the
way many people with mental health needs currently experience public services.
