Personalisation, I am in no doubt, would transform the lives of mental health service users and lead to better outcomes. Before I'd even heard of self-directed-support, I was lobbying for it. Why, I wondered, does nobody listen to my own assessment of my needs? There is one reason that appears to preoccupy the minds of everyone I've met involved in commissioning services: that of risk.
The other barriers are a lack of resources for early intervention, the separation of health and social care, and the lack of joint working structures between the different services and departments involved in a person's care.
But again and again I've heard the fear of risk expressed.
Fear of risk
So while service users desperately long to regain control of their
recovery, fear of risk stops personalisation in mental health moving forward. Despite
early pilots indicating this group to be among those who'd most benefit.
And of course, they have a point - nobody wants to hire a personal
assistant who turns out to be abusive.
However, given that a huge degree of risk already exists in mental
health services, it is an argument I find sadly illogical.
What, after all, is risk?
Risk is my friend with severe needs, who receives no services at all,
because she doesn't want other people to control her life.
Risk is another friend who asked for help, but only became eligible for
it after making a suicide attempt and becoming too ill to work again.
Agency failings
It's when agencies don't talk to each other. It's the breakdown I had
when all my services were cut off because I was suddenly re-housed outside the
borough. To be housed far from friends and family, with no money for food or the
tube, and nobody to visit or help you cook. That is risk.
To have those needs listened to and met at that difficult time would
have cost fifty quid a week. Not to have them met means I now cost £500.
Risk already exists then. Its existence is what led me into user
involvement in the first place.
Asking people what they need to keep well and meeting those needs, when
needed, can only result in an overall reduction of risk. That's a risk worth
taking.
Dealing with danger
The idea that all possible dangers must be eliminated, creates an
ineffective system. The fact is, the world is a dangerous place. And part of
the joy of life is the freedom to take risks. As a child, I climbed trees, played
conkers, used tea-trays as sledges, and went off on all-day bike rides with friends.
Without those things, my childhood would have been boring, miserable, and not
worth living - like the lives of too many mental health service users.
Ironically, by removing risk, then, you merely create it.
Personalisation is a chance to transform services, but we must not allow a mental health system to be developed around fear of litigation. Such a system stops people getting better, and prevents workers giving the help they want to give.
This is very well argued - I agree with much of what you say. I agree that mental health service users should have more say in what they need - money or other resources. My son whom I care for often says he feels powerless,and the agencies have not put in place what he needs to stay stable & out of trouble. Also, carers should have more say in these matters too!