'This Time it's Personal' first appeared in Mental Health Today in June 2011. To subscribe to the magazine click here.
Personal budgets are having a positive effect on service users with mental health problems, according to research
Robert Templeton, head of transformation at the Social Care Institute for Excellence (SCIE), knows that it's often a challenge to talk about personal budgets. Not only can it be a 'hearts and minds' job to win people over, but there are rumours in the media about how personal budgets are either unaffordable or can't work against a background of cuts. He is not daunted though; his job is to consider the evidence about what works and to show how personal budgets are making a difference to people with mental health issues.
Fortunately his job has been made easier by recent research. "I've been supported by our [SCIE's] latest research about people with mental health problems and older people who use personal budgets. It's a sort of 'state of play' report," he says. SCIE's report, 'Keeping Personal Budgets Personal', looks at the experiences of older people, plus people with mental health issues and their carers, across five study sites.
The study sites
The five SCIE study sites were mainly made up of those moving to a system where all new clients are automatically offered a personal budget if they want one. So they were all areas keen to make personal budgets 'the norm' in social care.
Service users comprised part of the team that carried out the research. Sixty-nine personal budget holders and carers, 40 practitioners and managers and 12 support provider organisations - including five user-led organisations - contributed to the research. It was not only councils involved; two of the study sites were joint mental health trusts.
Templeton says personal budgets and self directed support are an important aspect of providing more personalised services. "Our report, and an at-a-glance briefing specifically for mental health services, give an overview of how well personal budgets are currently working for people. What we know is that people who have personal budgets must be listened to so that they are really offered, and receive, the care and support they can choose and control."
The research provided two main conclusions. Firstly, people with mental health issues who use personal budgets need consistent contact with a worker who knows their circumstances. They also want consistent contact with one person throughout the time they are being assessed and during their time in support planning and review. This person would understand their circumstances and help plan for contingencies.
Secondly, mental health providers need to provide better quality information on the personal budget options available to service users. Also, service users want choice but can sometimes find that the social care and support market is not developed enough to allow a wider choice. The research also found that service users are generally able to manage their budgets, but often welcome support from others in a similar position, such as through peer support.
Hearts and minds
Some frontline professionals have also embraced personal budgets. For instance, Ken, a community psychiatric nurse in Lincolnshire who has been working with personal budgets for three years has been a supporter of personal budgets from the start: "They were first suggested by my team leader; we had a service user that he thought would be particularly suited to them," he says. " We saw the benefits for this person really quickly. We then started to use them for more and more people with mental health issues who use our services."
Ken's work contributed to the SCIE research. He says service users needed to be convinced about the merits of personal budgets. "It was a 'hearts and minds' job. Service users, a bit like me at the start, have approached the new system with caution and wondered what was 'in the small print'. But they have often been staggered about their new experiences. Prior to personal budgets, the system involved fitting people around services. Now it's vice versa and our job is to respond to ideas about creativity about personal budgets."
Ken says that people who use services often trust staff to know what works for them. For instance, one of his service users used to end up in hospital a lot. Since he started using a personal budget he has not been admitted nor had any crises. He knows that he'll get the time with the support worker to do the activities that are bespoke for him. So far, it's working.
Examples such as this have helped Ken when training up other community psychiatric nurses. "That's been very powerful because those who were 'personal budget refuseniks' didn't really have an answer to the evidence in front of them. However, I can identify with them if they are sceptical, because I was too."
One of the main advantages of personal budgets is that it caters to individuals, Ken says. "Take 'group sessions'; I know that this works for some people but not for others. I can think of one service user in particular who has used their personal budget to join a 'community group'. This is not specifically a mental health service user group but people with mental health issues can join. A difference that is subtle but very important. This has encouraged other service users to join the group. It helps, when perhaps a 'prescribed' group wouldn't."
Service user stories
Hilary has mental health problems and physical impairments. This means that she needs a high level of support from personal assistants and other services. She wanted the issue of 'risk and contingency planning' to be thoroughly addressed when designing her self-directed support plan. She felt really strongly about this. She discussed it with her social worker and they identified the potential risks to her.
For example, they identified the risk of what would happen if her personal assistant or her husband were not able to provide care. Hilary says: "To ensure I was able to minimise this risk I was provided with £500 for emergency cover. I now also have alarm systems which I can use in the house in case of emergencies."
She adds it was reassuring to discuss risks and then make contingency plans for dealing with them.
Helen, who also has mental health problems, lives by herself. While she gets support from her mother and her niece, she specifically wanted her community psychiatric nurse to help her through the personal budget application process. She had been quite ill for some time and it was her nurse who suggested that a personal budget might help improve her quality of life.
Before doing the assessment, Helen says she was "filled with fear and anxiety". But her nurse supported her and the assessment process proved to be straightforward.
Helen says: "I answered questions and ticked different boxes to say what help I needed. The nurse ticked what he thought and I ticked what I thought… some questions we disagreed on and then we discussed them to understand the questions better… so I understood a bit more and it became clear."
She feels she greatly benefited from doing her assessment with her nurse. "They were with me all the way and discussed it at good length. The relationship is very important, when you do need support with everything."
While there are positive stories out there, SCIE's Robert Templeton is well aware that some people are wondering how personal budgets can flourish - or in some cases, get off the ground - against a background of cuts. He says that it's important for SCIE to use its remit of reporting back from the evidence available.
"We need to keep an emphasis on outcomes alongside providing value for money. When people are in control of the way their care is being organised then progress is being made. Of course conversations about affordability are important. We do not want to lose the momentum, though, on revealing the great strides being made to improve people's lives, if people have a mental health issue and are a personal budget holder."
Also involved with the research were Acton Shapiro, the National Centre for Independent Living and the Social Policy Research Unit at the University of York. 'Keeping Personal Budgets Personal' can be found at www.scie.org.uk/adults/personalisation