The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here). It examines the overlap between Big Society ideas and recovery, personalisation and wellbeing in mental health.
Big Society provides new ways of looking at some of the most exciting and challenging changes faced by services for people with mental health difficulties. Personalisation, recovery and wellbeing represent an existing movement to bring the individual into the process of deciding the direction and type of care, treatment and support that they need while extending the frame of reference for mental health services beyond traditional boundaries.
All three are areas where the historic division between services, communities and individuals creates barriers to successful outcomes.
Personalisation of services is the direction that health and social care services were travelling in prior to the arrival of Big Society as an idea, but which resonates well with the Big Society concept of empowerment of individuals and removal of monolithic provision.
Within mental health, many service users, professionals and organisations have already begun the process of shifting from ‘one size fits all provision’ to the principles of personalisation of services.
At present, services are commissioned by one body, purchased by another and then presented to the actual person who will use them.
Personalisation, as a mechanism of direct choice, will completely change the relationship between people with mental health difficulties and the services that they use. It will also create situations where the role of the professionals not directly providing treatment will shift to guiding and supporting individuals to meet their needs in ways that those individuals feel appropriate.
Personal budgets will mean that individuals will be purchasers of services themselves directly through personal budgets. While there are ongoing national pilots of personal budgets within the NHS, some of which involve people with mental health difficulty, the major short-term impact of personal budgets is in the field of social care.
As of April 2011, anyone assessed by their local authority as having social care needs should, in theory, be offered a personal budget to spend on services or support to meet those needs.
Local authorities are at different stages in terms of providing this facility for people with mental health difficulties who have identified social care needs. There is currently a significant diversity of approaches to determining who is entitled to a personal budget, how the level of the personal budgets is calculated, what the personal budget can be spent on and how people with mental health difficulties can and should be supported in spending their personal budget.
Many local authorities are not yet in a position to explain the opportunities offered by personal budgets clearly to people with mental health difficulties, others plan to begin to shift social care provision to an almost entirely personalized model in the coming months.
Greater personalisation, both in social care provision and ultimately within the NHS, potentially offers significant opportunities:
- For user-led organizations to provide services that can be purchased through personal budgets
- For user-led organizations to provide services to support people with mental health difficulties in spending their personal budgets to meet their needs
- For groups of people with mental health difficulties to pool some of their personal budgets to pay for services (or other support) that meet their needs
Point 1 is both one of the great opportunities for personalisation (and The Big Society) but has the potential to be one of the most significant missed opportunities.
In the field of social care, work by local authorities to prepare small user-led organizations for the coming of personalisation has been distinctly patchy.
Probably due to the fact that local authorities themselves are – in many cases – unsure about the practicalities of providing personal budgets, there has, with honourable exceptions, been a severe lack of practical support available for groups who have been providing services funded by block grants but will in future need to sell their services to individual service users spending personal budgets.
The Big Society ideal for personal budgets is that service users end up with a wide choice of options for meeting their needs including sustainable service provided by user-led organisations and opportunities to use personal budgets to do their own thing outside a structured framework of service provision.
As personalization is rolled out in social care and personal budgets increasingly become available to NHS service users, the NHS has a key role in supporting service user-led organisations to enable them to make this happen.
EXAMPLE: In Leeds, Keeping House, a Leeds City Council funded initiative to encourage the development of services that help people to live independently, has launched Ideas That Change Lives – a scheme to invest in and support the development of new socially enterprising ideas to support independent living.
The scheme will invest £10,000 in the six best ideas generating by the local community and provide a package of business support to enable the people with the ideas to take their projects forward.
The scheme also offers smaller ‘Kick-Start’ grants of up to £2000 to help individuals and organisations to turn ‘ideas which have potential’ into ideas that gain a greater level of support.
Those developing ideas for investment are encouraged to attend an Investment Application Planning Session and use a specially developed Business Plan Template to submit their application.
Applicants are encouraged to call and speak directly to the team managing the programme. There is an emphasis both on the importance of developing sustainable and well-planned social business ideas, and also on people who have ideas for services but don’t feel that they’re business experts getting the support they need to make their ideas a reality.
Recovery and Wellbeing
Within mental health personalisation has crossed over with the development of two important additional processes of rethinking the manner in which individuals are supported to reach their potential: Recovery and Wellbeing
Recovery puts the individual at the heart of defining what the outcomes for her or his treatment should be. It takes as its very principle the proposition that services should not try to judge where an individual should end up, but support them in their journey toward the point that they define, which may encompass far more than medical measures of freedom from symptoms. In actuality, recovery represents a way of acknowledging that the needs of individuals with mental health difficulties may change over time and fluctuate depending both on conditions but also life situations.
The gradual move to a wellbeing-focused approach represents a fundamental reconfiguration of the way in which the NHS regards its role in the lives of the people who use it. Rather than asking the question ‘what do we do for people who are ill?’ it poses the question ‘what do people need to be well?‘
In a mental health context, this presents a number of challenges and opportunities.
The first is the challenge already recognised by No Health without Mental Health and its emphasis on early intervention. This takes a reorientation of services to recognising what needs people have and meeting them as quickly and efficiently as is possible.The second is a wellbeing approach extends the terms of engagement in mental health far beyond the walls of the consulting room, GPs surgery or ward.
All together, personalisation, recovery and wellbeing can only work in a system where flexibility exists and where people with mental health difficulties determine their own outcomes and goals.
Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.