How to make personalisation ‘core business’ in mental health

Compared to adult social care, mental health is lagging behind on personalisation – partly as a result of the continued dominance of the clinical model of mental health.

In Stockport, things are different. Four years on from the town piloting personal budgets, over 350 people now use them to buy services they feel will boost their mental health recovery, whether it’s a personal assistant, bike or photography equipment.

Social worker Nick Dixon, commissioning manager at Stockport council, admits that the process of making personalisation – or self-directed support – “core business” in mental health services hasn’t been quick or easy.

“We’ve been working on this for 10 or 12 years in terms of changing the culture in services,” says Dixon. “That’s not to say the clinical model isn’t important – of course it is – but to us the weighting was all wrong. It was to the exclusion of what matters to people’s lives.”

So how has Stockport succeeded in offering personalisation in mental health when so many other councils are failing to do so?

Senior support

Dixon says that the backing of local councillors and senior leaders like Terry Dafter, Stockport’s director of adult services, has been vital.

Support from Dafter (who is also the Association of Directors of Adult Social Services’ mental health lead) was key when Stockport confronted the initial cost of self-directed support. Dixon and colleagues were confident personalisation would reduce dependency on services in the long-term but they also knew that costs could rise in the short-term.

“And for three years the budget went up. That kind of thing makes accountants nervous but Terry just told us to keep going. He’s driven by the same values we are. He takes positive risks,” says Dixon.

“Now the data shows that the cost has levelled out. People are coming into the system all the time but we’ve also got people coming out the other end as outcomes are met.”

Reaction from the frontline

Karen used her creative skills in her support plan

Support from frontline staff has also been key. When implementing self-directed support, Stockport put in a raft of support mechanisms to engage care coordinators in the process. These included regular training sessions and weekly clinics where staff could raise concerns.

“So there were lots of avenues that people could go to ask questions, almost to be given permission to cross the line from traditional ways of working,” explains Carmel Bailey, social care lead for Stockport’s community mental health services at Pennine Care mental health trust.

“For a lot of professionals – and I include myself in this – it was a real adjustment at first,” adds Bailey.

The presence of service user representatives and an independent brokerage service on a steering group was also instrumental in getting personalisation off the ground.

“It gave us a really good balance,” says Bailey. “They challenged us. It was tense at times. But without them I think we may have swung too far towards trying to justify how we were spending every pound.”

Follow-up support

Barry Tildsley, one of Stockport’s personalisation coordinators, says the ongoing support for frontline staff charged with implementing self-directed support often isn’t in place elsewhere. Instead services often hold “one big training day” around personalisation and think that’s enough.

“Then people just go off and quickly go back to what they were doing before. You need follow-up,” he says.

Tildsley says personalisation has tapped into his creativity. Seeing the difference personal budgets make to some people’s lives has “been inspiring”. Most frontline workers, he says, share his enthusiasm for self-directed support although “the odd one or two” have found it uncomfortable.

Bailey says a handful of care coordinators still “don’t get” personalisation but many welcomed the flexibility of personal budgets to offer new solutions for people whose needs were not being met by traditional services.

“Those people complained – understandably – on a regular basis. That took a huge toll on care coordinators, team managers and those people. So there was almost a sigh of relief that self-directed support meant we could now discuss other ways to meet those needs,” Bailey says.

‘It has opened my life up completely’

For Karen, personalisation has been a positive experience. Before using her personal budget to buy a car, anxiety and physical health issues meant Karen felt “virtually housebound”. She depended on other people to drive her to services or community groups and “felt like a burden” no matter how many times people insisted otherwise.

Having a car has helped Karen attend community activities, including art and gardening groups. As a trained photographer she now volunteers to run a photography group too (all photos in this piece are all by Karen and used with her permission).

“When I got the car log book and my own insurance, it just boosted my feeling of being an independent woman again,” says Karen.

“Before I got poorly I ran my own business. Having fallen so far down and felt like there was no hope, I’ve slowly built my life back up again. Having the car has just opened my life up completely.”

A watershed moment

The first time Stockport spent money on a car through self-directed support was a “watershed moment”, recalls Dixon. Some staff were sceptical and there were concerns over hitting the headlines given the media’s lust for slapstick coverage of personal budgets.

“We had a debate. It was in the context of ‘this might not feel comfortable but, trust us, we think we’re doing the right thing’. We’ve always tried to have open conversations,” says Dixon.

Four years on, Stockport’s team are still having those conversations. In March of this year, people used personal budgets to buy gym memberships, computers, childcare, bicycles, walking shoes, gardening tools, respite care, pet care, transport and much more.

In the meantime, the local self-directed support model continues to be tweaked. Dixon feels the next challenge is to shift commissioning away from the “risk averse, lowest common denominator” approach that has long-dominated statutory services towards pathways co-produced with people who use services.

“When I came here in 2001 I had no idea about personalisation. When I heard about it I thought ‘wow, this is putting recovery in action. This is giving people choice and control and putting trust in them to know what works’,” Dixon says.

“Now I’m a commissioner I can play a part in helping bring about this change. I am not saying it’s easy. Sometimes I went home and felt overwhelmed with the scale of the challenge but I knew it was the right thing to do. Key to success is the team around me, I am just a part of it, together we have shown it is achievable.”