After a slow start the take-up of direct payments among disabled people is increasing. But, writes Lauren Revans, it is a different story among mental health service users.

The Department of Health announced last week that an estimated 2,500 disabled people now receive direct payments across the UK.

This is a marked improvement on the slow implementation and uptake rates after the scheme was officially launched in April 1997.

Direct payments were designed to allow disabled people to manage and pay for their own care, rather than having it organised by their local social services departments.

But, while the word on direct payments is finally spreading, there are certain groups of disabled people who have been left out of the conversation.

The National Centre for Independent Living, which supports disabled people living at home, says it is aware of only 10 mental health service users in the UK who receive direct payments. People with learning difficulties have been slightly more successful, but still only represent a tiny proportion of direct payment users in comparison with people with physical disabilities.

The reasons behind the scheme's variable dispersion across the community are manifold. To begin, it was largely disabled people who campaigned for the right to receive direct payments. This raised awareness among that group and automatically gave them a sense of entitlement other groups do not share.

Then there is the historical problem of contact between mental health service users and social services departments. Disabled people have traditionally had their day-to-day needs met by social services departments but mental health service users deal with a mix of professionals and their only point of contact with the care agencies might be a community psychiatric nurse.

The wording of the Community Care (Direct Payments) Act 1996 and subsequent guidance was also deemed by mental health service user representatives to be geared largely towards disabled people.

Independent living advocate Katy Murray complains that the language of the 1996 act is not broad enough and does not encourage imaginative interpretation. In Essex, four people with mental health problems and 20 with learning difficulties now receive direct payments. But that still only represents a fraction of the total 260 disabled people on the scheme locally.

"I believe the act is supposed to be all-encompassing, but the terminology and language has not allowed people to think like that," says Murray. "The term personal assistant, for example, appears to conjure up a view of a physical assistant supporting with physical intervention."

But the major problem mental health service users and people with learning difficulties face in terms of gaining access to direct payments appears to be the varying degrees of ignorance, anxiety, and reluctance displayed by local authorities and professionals who are in a position to promote the benefits of the scheme to potential users.

"Mental health users miss out because care managers don't know enough about the legislation and how to use it," NCIL development officer Laura Luckhurst says. "Social services need to avoid discriminating against whole groups of service users by offering direct payments to some groups but not others."

There are many examples where the need for direct payments among mental health service users and people with learning difficulties are not even being considered, let alone met. In one case, a young man with learning difficulties who wanted to use direct payments to pay for a special school outside his local authority area was refused access due to lack of resources. Others have been considered unsuitable because of their fluctuating need - despite the flexibility of the direct payment schemes being one of its key advantages.

Deputy director of learning difficulties charity Values Into Action, Catherine Bewley, says the two big sticking points are the issues of consent and management. She criticises the lack of effort made to put people in a position to give their informed consent by helping them to understand the scheme, but also says there is misinformation about consent as a legal issue.

User groups argue that it is discriminatory to assume that people with mental health problems or learning difficulties cannot cope with direct payments. They want more emphasis to be placed on the entitlement under the legislation for people to manage direct payments "with assistance".

Direct payments adviser at the Centre for Integrated Living in Cheshire, Sheila Murray, says: "Mental health service users often can't take on the whole role of the employer. But as long as the person has control over who the people are, when they are coming, and what they do, then that's all we look at. The actual administration side can be taken over by anyone."

The benefits of the direct payments scheme for people with mental health problems and learning difficulties are evident. Examples include a handful of mental health service users who self-harm and are now using direct payments to pay personal assistants to carry out activities deemed potentially dangerous, such as cooking and ironing, and to be with them at times when they are likely to feel vulnerable.

But there is a long way to go before such examples become the norm. A spokesperson for the Mental Health Foundation and the Foundation for People with Learning Disabilities says: "You can't just assume that people can or cannot cope because of their diagnostic labels."