A project led by Mind to tackle the low take-up of self-directed support among mental health service users has returned some positive results, writes Jeremy Dunning
When Tony Martin took up a direct payment four years ago he was only the second mental health service user in Derbyshire to do so.
Latterly, the 53-year-old has been part of a government-funded project to assess and tackle the still low take-up of direct payments and personal budgets among mental health service users, relative to other client groups.
The Putting Us First project, overseen by charity Mind and delivered by the University of Bristol’s Norah Fry Research Centre, ran from October 2008 until March this year. It aimed to increase take-up of personalised care among mental health service users and change professional attitudes that stood in the way.
Martin was one of its four champions – mental health service users receiving self-directed care appointed to champion personalisation in their areas.
An evaluation of the project, which also included focus groups with service users, a national conference and the publication of a series of information booklets, has been seen exclusively by Community Care.
It concluded that there was “considerable confusion [and] misinformation” about personalisation among mental health service users and the professionals who work with them.
The evaluation found a lack of trust among some professionals who felt that mental health service users lacked the insight to manage their care. For their part, some service users associated personal budgets with “disability” and did not identify themselves as disabled.
The job of the champions was to tackle these attitudes by raising awareness and delivering training to professionals, and to use their own experience to convey the benefits of personalisation to service users.
The four champions covered Sandwell in the West Midlands, Derbyshire, Hertfordshire and Poole and rural Dorset. Each had differing approaches, based on their past experience and local knowledge.
They reached 630 people at 90 events. The content varied from one-to-one sessions with professionals or service users to presentations for larger groups on how direct payments could be used. There was also a regional conference.
Although the champions’ work lasted only six months, the evaluation found that offers of direct payments to mental health service users increased, reflecting the change in the attitudes of professionals.
One visited a community mental health team, expecting 15 minutes of questions, but was kept for two hours because of the team’s limited knowledge of direct payments, let alone personal budgets.
The report said a key indicator of the need for the champions’ work was that, in two of the areas covered, neighbouring councils were keen to invite the champion in.
Feedback to the champions from professionals who attended training events was “universally positive”, the report found.
It concluded: “What the champions achieved was at least the start of an attitude change, so that professionals could see the positive side of personalisation.”
Mind’s policy and campaigns manager, Anna Bird, says: “It was important for professionals to realise that a personal budget wasn’t just about handing over a pot of cash to an individual. It’s about the individuals choosing the services.
“That’s where the champions’ work has been vital because they’ve been able to spend a lot of time with the professionals in their area providing information, and beating myths about what personal budgets are all about.”
The report was positive about service users taking on champions’ roles more widely but emphasised that they would need adequate support given the added strains of the responsibility.
Dr Val Williams, lead researcher for the project at the Norah Fry centre, says: “This could be the start. It shows how champions’ work could proceed. It does need planning. It needs more time and it does need support.”
Still hindered by old-style thinking
The stigma of mental illness is prevalent throughout society, writes Richard Shrubb. Even those whose job it is to work with people like me make assumptions about our capacity. You take someone in early stage treatment, sedated out of their brain on medication, and the truth is they barely have the capacity to tie two sentences together.
I went through that phase. On first-generation antipsychotics, I could go for hours between thoughts, sitting in a chair. But that’s early phase treatment. As I recovered from the drugs daze, I started to be able to think ahead and plan, leading to a master’s degree and a profession of my own.
The personalisation agenda should help us move forward to the place I am in, not keep us in our medicated states in chairs.
Historically, take-up of direct payments has been lowest among clients with mental health problems. A Social Care Institute for Excellence (Scie) briefing on implementing individual and personal budgets in social care, updated last year, said this may be due to staff attitudes and expectations of service users.
Sarah Carr, senior research analyst at Scie, says staff “assume people with such problems won’t be able to handle them.”
Councils have been set a target of having 30% of service users on personal budgets by 2011. But Mike Murkin, development consultant at regional improvement agency the South West Development Centre, does not think this will apply to mental health service users.
He believes the emphasis on keeping us safe from ourselves or others clashes with the essence of personalisation. “The mental health system has a genuine emphasis on risk management,” he says. “Sometimes that agenda clashes with enablement.”
Michael Patterson, director of social care consultancy Support Solutions, has a compelling metaphor for the balance between risk and empowerment. “It is about having a fence at the top of the cliff to prevent people falling,” he says.
But the current approach is about straitjacketing us so we don’t go near the cliff in the first place, whether to enjoy the view or because, in their eyes, we’d go there to jump off.
That’s rather old-fashioned thinking, and goes against a progressive and modern approach to care and support.
Richard Shrubb is a journalist and mental health service user
Case study: Tony Martin, personalisation champion
‘The crux of the problem is ignorance in the service teams’
Tony Martin has been speaking up for people with mental health problems since he started using services 15 years ago. In 2006 he took up a direct payment and became a convert to personalisation.
When the Department of Health started piloting individual budgets in 2005, he was appointed as a citizen leader tasked with promoting self-directed support.
Becoming a Mind personalisation champion was an extension of what he was doing already, though the cachet of saying he was working for Mind helped open more doors.
Martin aimed to increase the number of mental health service users with a direct payment in Derbyshire. As champion, he used his established links with the local primary care trust, the county council, government and with service users and service user forums.
He even held a conference on personal budgets to disseminate thinking. Attended by 140 people, including professionals, carers and service users, all groups felt they had learned a great deal.
Tackling professionals’ attitudes and levels of knowledge about personalisation was key.
Martin says: “The real crux of it is ignorance in the service teams about how a direct payment can be used differently in mental health compared with in other groups, such as people with disabilities.
“It’s no good thinking about how you can get people out of bed. It’s about being able to give us new focuses and new interests in life and improving our quality of life.”
The short timeframe of the fieldwork meant success was not so much about more people receiving a direct payment by the end of the project but about expressions of interest.
However, by March this year there were 52 mental health service users with a direct payment in Derbyshire, up from 16 in September 2009, when Martin started his work as a champion.