SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets

Practitioner attitudes

'Practitioners may be selective in terms of [who] they offer cash payments, which can impact on opportunities for people with mental health problems, dementia or learning difficulties' (Arksey, 2008)

Attitudes to competence and capacity

In their 2007 review on attitudes to risk, Mitchell & Glendinning found very little research on physically disabled people or those with sensory impairments. Studies tended to concentrate on:

• risk, 'danger', mental capacity and competence for people with mental health problems
• physical risks for older people
• competence and some positive risk taking for people with learning disabilities.

The majority of the research also focused on practitioners rather than people who use services.

Additional findings indicated that:

• carers and families of older people and people with learning disabilities can have more influence on defining 'risky behaviour' and risk management strategies than the person using the service
• in some cases older people took self-assessed risks 'covertly' to remain in control
• for older people the benefits may be linked to psychosocial effects such as feelings of wellbeing associated with greater independence, control and a sense of 'normality'.

Findings on professional assumptions or anxieties about people with mental health problems were clear:

This was particularly true for black people. This was reflected in other findings about black and minority ethnic people with mental health problems sometimes having less access to direct payments, often due to practitioner perceptions of risk.

Further reading

• Arksey H & Kemp P (2008) Dimensions of choice: a narrative review of cash-for-care schemes Working paper No DHP 2250 York: University of York, SPRU (158kb PDF file)

• Mitchell W & Glendinning C (2007) A review of the research evidence surrounding risk perceptions, risk management strategies and their consequences in adult social care for different groups of service users: Working Paper No. DHR 2180 01.07 York: University of York SPRU

• Spandler, H. and Vick, N. (2005). 'Enabling access to direct payments: an exploration of care co-ordinators decision-making practices.' Journal of Mental Health, 14(2), pp 145-155.