At a glance 18: Personalisation briefing: Implications for community mental health services

Written by SCIE in collaboration with the AMHP National Leads Network and the Social Care Strategic Network for mental health.

Published: November 2009

Key points

Personalisation for community mental health services means:

  • making sure people with mental health problems can take as much control as possible over their support arrangements, to pursue their recovery and social inclusion on their own terms
  • committing to developing a more equal and creative relationship between people using services and practitioners
  • closing any gaps of understanding and procedure between local authorities and provider NHS Trusts to make sure self-directed social support can benefit people with mental health problems
  • having relationship-based rather than process driven ways of working, changing your own personal practice as a community mental health worker or manager
  • dealing effectively with the specific challenges of risk management, fluctuating conditions and public stigma to make sure people with mental health problems benefit equally from more choice and control
  • adapting job roles, the organisation of teams and the allocation of resources over time to make sure services can meet people’s needs and aspirations in more personalised ways.

Introduction

This briefing examines the implications of the personalisation agenda for practitioners and managers in community mental health services.

Personalisation means thinking about care and support services in an entirely different way. This means starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives. It requires a significant transformation of all adult social care services including mental health, so that all systems, processes, staff and services are geared up to put people first.

The traditional service-led approach has often meant that people have not received the right help at the right time and have been unable to shape the kind of support they need. Personalisation is about giving people much more choice and control over their lives and goes well beyond simply giving personal budgets to people eligible for council funding. Personalisation means addressing the needs and aspirations of whole communities to ensure everyone has access to the right information, advice and advocacy to make informed choices about the support they need. It means ensuring that people have services such as transport, leisure and education, housing, health and opportunities for employment regardless of age or disability.

What are the implications for community mental health services?

Personal budgets and self directed-support

There is emerging evidence, for instance from the IBSEN evaluation of the then individual budget pilots, that people with mental health problems may have the most to gain from increased choice and control over their support arrangements. Support available to date has often been inadequate, unsuitable or unacceptable. The benefits of choice will be most effectively realised through greater integration of health and social care resources (Glendinning et al 2008). However, perceptions about risk have sometimes compromised access to and uptake of, options like direct payments for people with mental health problems (Carr & Robbins 2009).

Personal health budgets are also being piloted for England. These will build on the experience of personal budgets in social care and test out ways of giving people with long term conditions, like mental health problems, greater control over the health services they use.

A direct payment is only one way to receive a personal budget. The following points are crucial for understanding how personal budgets work:

Self-directed support involves finding out what is important to people with social care needs and their families, and helping them to plan how to use the available funds to achieve these aims. Implementing self-directed support in social care means ensuring the following elements are in place:

We stopped talking about my ‘needs’ and started talking about how I wanted to live my life.

Person with a progressive neurological condition using direct payments

Challenges for mental health

While there are common principles for implementing personalisation for everyone requiring social care resources, there are some particular challenges in mental health.

Personalising the journey through mental health community services

Personalisation encourages you to think about what it is like for someone trying to navigate the system – to walk in their shoes. Your role is to empower them to find the sort of support most appropriate for them as an individual. This may mean facilitating access to services, resources and opportunities for meaningful occupation, leisure and education. In some cases it may mean helping people to make choices and identifying who else in their social circle of support might be helpfully involved in that. It is also important to discuss specialist support options if the person is, for example, from a black or minority ethnic group, or identifies as lesbian, gay or transgender.

In order to do this, you will need to have:

Personalisation challenges the traditional notion that staff and managers know what is best and determine what someone should have. While professional expertise is important, our challenge now is to improve how we share our expertise and respect the experience and expertise of people using services, their families and friends who are often in the best position to identify both problems and solutions.

Stages in a person’s journey

The following section offers an overview of some main stages in the journey through services that a person might experience – and how as a practitioner or manager you can work differently to personalise each stage. The stages are not exhaustive and do not necessarily happen in this order. Different stages may also be revisited or happen in tandem. The suggestion here is intended to get you thinking and to recognise that personalisation has relevance to all aspects of your work.

... when a person with mental health problems:

… is in touch with primary care services:

  • Is there anything I can do to give earlier, more preventive responses to people in touch with primary care?
  • Can I facilitate better access to primary physical health care for the people I work with?
  • How can we work with partner organisations to develop better universal access to information and advice about mental health issues and provider services?

… needs crisis and home treatment services:

  • Is the service ‘holistic’, offering psycho-social intervention at an early stage?
  • Does it provide enough advice and information to carers, or family members or friends involved?
  • Does this service link well with services providing ongoing support?
  • How easy is it to access?

… experiences a Mental Health Act assessment:

  • Are Approved Mental Health Practitioner (AMHP) assessments in my team organised and carried out in order to maximise the control a person can retain over the situation?
  • Are suitable advocates (both formal and informal) routinely involved in assessments?
  • Are resources and personalised plans available to provide alternatives to admission where it is safe and appropriate?
  • Are AMHPs able to appropriately influence the ongoing support plans of people they assess?
  • Have we discussed with the local authority/Northern Ireland health and social care trust how new alternatives to admission might be created?

Example: AMHP, Hertfordshire

This time, when Jenny was assessed under the Mental Health Act, I talked to her about what was most important to her at this point. It was the safety of her children. She was able to spend time with her children before leaving the house, reassuring herself the arrangements for them were OK. I then made enough time to talk about whether she could leave the house without further restraint. She had been held by several police officers on all previous occasions and this time she could walk to the ambulance unrestrained. This Mental Health Act assessment was a very different experience for her. She retained more control and she remembered this when she felt more well – it gave her hope of change.

… needs to access an ongoing community mental health service:

  • Can I offer more choice of appointment time and places, and/or choice of who the person sees?
  • Are my letters easy to understand and free of jargon and is the team’s telephone manner always helpful and courteous?
  • Can I offer good access to specialist support, translation and interpretation?
  • Do I routinely suggest to people that they might create their own agenda in advance of their first and subsequent appointments?
  • Do I invite them to bring someone with them?
  • Do we have quality standards in our team for information provision at different stages of contact with the service?
  • Can I let them know how to complain and signpost access to independent advice?

… experiences assessment, review and care coordination:

  • Is self-directed support and self-assessment for social care resources the standard approach for initial or subsequent assessments and is risk management part of the discussion with the individual?
  • Do I and all colleagues understand personal budgets?
  • Is there a clear, accessible assessment document produced with the person that they can take away with them and refer back to?
  • Do I and colleagues understand Fair Access to Care Services eligibility criteria and financial assessments?
  • Do I and colleagues understand how support planning is changing and can we ensure people using our services benefit from this?
  • Have we received training on how the CPA and care coordination role will evolve in response to personalisation?
  • Am I routinely considering direct payments for all eligible and willing people with capacity to use them?
  • Do I routinely review that a self-directed support self-assessment has been offered and undertaken as appropriate over time?
  • Are all CPA meetings organised such that the person using services and their circles of support from families and friends take optimal control over how, where and when it happens and what is on the agenda?
  • Is there a coherent approach to risk management and safeguarding that focuses on the individual?

Example: Person with a progressive neurological condition using direct payments, Oldham

The thing that has really changed was the types of conversations I had with my social worker. We stopped talking about my ‘needs’ and started talking about how I wanted to live my life which made much more sense and opened up new opportunities. It was so different for me – and for her!

… is part of a family or other important social network:

  • Do I talk routinely with people about their social circle of support or the one they would like to create?
  • Do I routinely try and involve families, friends and carers in support planning, (with the person’s consent) to make mental health support more effective and to promote the individual’s mental health management and help prevent relapse?
  • Do I pay enough attention to sharing my knowledge and skills with families and friends, to help them in their supporting roles?
  • Do I make sure I know who the substantial carers are and whether they might benefit from a personalised carer’s assessment in their own right?

Example: Father of man using long term mental health services, South London

The psychiatrist had been telling me for months that he couldn’t tell me about my son John’s treatment, including his medication – he said John doesn’t want me to know. John has been quite unwell and it has been difficult to talk much with him recently even though he is back living with us. When I finally did raise this issue with John and asked when he had told his psychiatrist that he couldn’t tell us about his treatment regime, John was adamant he had never told him that and that he certainly hadn’t asked him recently. John then got a new care coordinator who was really comfortable talking with me and my wife. She told us about advance statements – that John could say what he wanted to happen in the event that he became ill again, including what information he wanted shared with us. No one had told us about that before. It was a revelation. The care coordinator came to the house, offered practical advice to us as a family and made all of us including John feel we had an active, adult part to play in moving on.

… wants to feel a fuller part of society:

  • How well informed am I and my colleagues about the opportunities that people might access from local community, education, leisure and employment resources?
  • Do we monitor and review the social inclusion progress of the people we work with?
  • How do we address equality and diversity issues, such as those for people from black and minority ethnic communities or for people who identify as lesbian, gay or transgender?
  • What are we doing enable people to stay in work if they have a job?
  • How can I and my team help people with housing difficulties?
  • What are we doing to challenge stigma and discrimination against people with mental health services and to promote positive attitudes in other public services and in the local community?
  • How am I working to enable this person to discover and build on their strengths, social networks, interests and activities to improve self-confidence, independence and self-determination?

Further information

There are many sources of further information on personalisation. Here is a short selection of helpful resources:

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  • Personalisation briefing: Implications for community mental health services

Personalisation briefings

What is personalisation?

Personalisation means recognising people as individuals who have strengths and preferences and putting them at the centre of their own care and support. The traditional service-led approach has often meant that people have not been able to shape the kind of support they need, or received the right help. Personalised approaches like self directed support and personal budgets involve enabling people to identify their own needs and make choices about how and when they are supported to live their lives. People need access to information, advocacy and advice so they can make informed decisions. Personalisation is also about making sure there is an integrated, community-based approach for everyone. This involves building community capacity and local strategic commissioning so that people have a good choice of support, including that provided by user-led organisations. It means ensuring people can access universal services such as transport, leisure, education, housing, health and employment opportunities. All systems, processes, staff and services need to put people at the centre.