Personal budgets, direct payments and self-directed support for people with severe mental health problems

SPRU research team

• Martin Webber (Principal Investigator)
  

External collaborators

• Tom Craig
• Martin Knapp, Personal Social Services Research Unit (PSSRU), London School of Economics
• Michael Dewey, Institute of Psychiatry, King's College, London
• Patrick Gillespie, South London and Maudsley NHS Foundation Trust
• Nick Hervey, South London and Maudsley NHS Foundation Trust
• Jerry Tew, Institute of Applied Social Studies, University of Birmingham
• Sarah Carr, Social Care Institute for Excellence
• Michael Clark, NIHR School for Social Care Research

Project summary

Background

Local authorities are required to offer personal budgets to all people eligible for ongoing social care by April 2013. Personal budgets provide service users with more freedom to purchase care and support from people they feel comfortable with, such as friends or family; or to fund activities to enhance well-being and promote social inclusion such as a gym membership, a college course or a taxi fare to a local library, for example. Direct payments are an alternative funding mechanism for personalising care and these are frequently used for one-off payments for specific items or services. However, only 6.5% of adult social care users received a personal budget or direct payment in 2008-9 and the take-up is particularly low among people with mental health problems.

Seventy-five Primary Care Trusts were piloting personal health budgets for people with long term conditions such as mental health problems to explore how the principles of personalisation may be extended into the NHS at the time of the research. However, there was limited evidence of the effectiveness of personalised care in mental health services.

This project was led by Martin Webber in the School for Business and Society at the University of York. Professor Gillian Parker provided input on issues around the role of personal budgets in supporting parenting.

Aims

Personalised care can comprise of a personal budget or direct payment, and self-directed support. It is important to have gold standard evidence of its effectiveness for people with mental health conditions. This project carried out initial research to test the feasibility and inform the development of a full evaluation programme of personalised care.

The objectives of this development project were to:

• develop an exemplar of good practice in personalised care from the perspective of mental health service users, carers, clinicians and policy makers to inform the proposed programme grant
• review social and clinical outcomes in published evaluations of personal budgets, direct payments and self-directed support
• explore the acceptability and feasibility of undertaking a cluster randomised controlled trial of personalised care within NHS Mental Health Trusts
• explore ways of overcoming potential barriers to the success of the proposed research programme, including professional and service cultures that may be resistant to change
• evaluate the potential impact that merging personal health and social care budgets will have on the proposed programme
• further develop the plans for the individual work packages of the proposed programme.

Policy and practice aims

The personalisation of social care services and the imminent introduction of personal health budgets nationwide made it timely to evaluate the effectiveness and cost-effectiveness of personalised care in mental health.

Additional information