'Change of culture' needed to ensure positive use of self-directed mental health support

The Brent  Health and Wellbeing Board on Thursday 6th October has a heavy agenda but the report on Brent Mental Health User Group's (BUG) research into the use of self-directed support is well worth a substantial discussion. LINK

Although overall the findings are positive the recommendations point to areas of tension which are worth investigation, including the possibility that is some cases the support may be directed by others who think they know better than the user about the support they need:

Recommendations from the report include:

·      Ensure that staff maintain the ethos of self-directed support, enabling individuals to use direct payments in ways that they feel will meet their social care needs

·      Individuals need to have more choice about their personal assistants and staff need to work with them to ensure they feel in control of their relationship.

·      Staff need to work with individuals to enable them to identify and utilise personal assistants to do what they feel motivates them as opposed to what staff think will motivate people

·      Individuals need to be actively involved in measuring their progress; flexibility to meet individuals changing needs also needs to be incorporated

·      The role of personal assistants needs to be distinct from that of staff in specialist mental health services

·      Where individuals are using personal assistants via agencies, the role of the agency needs to be clear

The section of the report on 'Changing the Culture' is key:

While some progress towards change has been made, mental health services do continue to use the traditional, chronicity approach – characterised by staff ‘managing risk and care’. This represents a barrier to achieving consistent use of self-directed support by individuals using services to deal with mental health issues.

 Service providers need to replace this approach with all elements of a wellbeing and recovery and personalisation approach which is consistent with national expectations of services.

Staff need to be provided with comprehensive wellbeing and recovery training such as that designed and run successfully by BUG for some years, based on the approach developed together with people using services, carers and clinicians from a range of disciplines by National Institute for Mental Health England (NIMHE). Staff need to work with people as unique individuals in the context of their lives, in equal partnership, facilitating their identifying what they feel will enable them to improve all aspects of their wellbeing and move towards recovery. Staff’s practice needs to incorporate a strengths-based approach – recognising and building on people’s strengths and engaging with their intrinsic motivations as opposed to trying to create artificial motivations. As well as using reframing skills to challenge negative assumptions about individuals and turn them into opportunities to get to know and work with them as individuals, staff also need to use a positive risk- taking approach, enabling individuals to stretch themselves and try new things in order to achieve their potential.

Use of self-directed support needs to be incorporated, including to facilitate a personalisation approach, enable individuals to address all aspects of their wellbeing, develop their self-management and utilise community resources. Individuals who took part in the survey talked about how use of self-directed support had enabled them to regain their loss of identity as well as having developed a sense of purpose in life.

Other recommendations follow:  

Individuals Being Actively Involved in Their Use of Self-Directed Support

People’s response to this research has indicated that they are often not aware they are using self-directed support.

1.  Experience to date has indicated the importance of people using services leading to a greater extent as opposed to staff deciding what will motivate them. People also need to be actively involved in their use of self-directed support.

Creating Opportunities for Individuals to Meet Each Other

People do not have many opportunities to meet each other.

1.  Opportunities need to be created for individuals using direct payments to meet and gain peer support from each other, sharing their experiences and finding ways of resolving any difficulties.