What’s the problem with personalisation and mental health?
If we reflect on the main challenges that less than ten years ago prompted personalisation as a policy concept, they were about: people needing more control over their lives and services, developing a different range of service options that better reflected what people wanted, applying pressure on services to demonstrate better outcomes and increasing the focus on community or social capital as part of people’s lives.
These are all major issues for people with mental health problems – so why is it that progress towards personalisation in mental health is not as advanced as in other areas?
Those reasons are probably a book rather than a blogpost. Some stem from personal budgets having become the core indicator of personalisation progress. There is a belief from some (particularly mental health professionals) that personal budgets are inappropriate for people who are experiencing or are at risk of, serious mental ill-health. They argue that the statutory duty around risk prevention outweighs the expectation or benefit of promoting personal budgets and so traditional approaches remain and personal budgets are consigned to the ‘too hard’ category.
Similarly, it is argued that the amount of responsibility involved in taking on a direct payment may be too much for a person in times of mental health crisis and so that step should not be taken – even in times when people are comparatively well.
These are valid concerns that need to be built into local delivery mechanisms, but they are not insurmountable – if only because the underpinning belief statement to such inaction is that people with the more complex mental health problems do not have the right to expect greater choice and control over their lives and services. This should not be accepted and, beyond the belief system, there are ways around such challenges. For example; the early development of personal health budgets has shown some of the ways in which progress can be made; personal budgets are far more than direct payments and, when and where people do not want that degree of responsibility approaches such as individual service funds offer alternative strategies.
However, my hunch is that the greatest obstacle to progressing personalisation in mental health is that, across most of the country, the lead rests with the NHS. Personalisation was a concept that was supposed to apply to the healthcare system as well – but, other than the small personal health budget initiative it is largely absent in the policy rhetoric and DH expected deliverables. Other demands like the implementation of payment by results have gained greater priority in the minds of managers and leaders and there are valid concerns that the PbR framework may not exactly chime with the personalisation agenda. As one NHS Trust Chief Executive told me the other day: "There is nothing I’m being judged on delivering other than balancing the books and implementing PbR”.
Add to this the fact that many local authorities see mental health as a comparatively small area of their remit nowadays that they have focused their personalisation efforts in areas such as disability and ageing, and it is easy to see why personalisation in mental health has hardly taken off in many locations.
Yet it need not be and it should not be.
The key elements of what (almost) everyone in the mental health sector says are important (recovery, social inclusion and the voice of the individual) are at the core of the personalisation agenda. Put another way, at a time when financial constraint are consuming our attention, a whole-system focus on making a reality of personalisation could help to put those things back on the top of everyone’s agenda – giving people more control over their services, listening to the voice of the person, developing new service options, promoting community connections and, through those things, sustaining recovery.
I don’t normally use my blog to publicise NDTi work, but what has particularly prompted me to write this is the launch of ‘Paths to Personalisation’. Over two years ago, the DH commissioned NDTi to write good practice guidance in how to implement personalisation in mental health services. Unfortunately, completion of that work (the original ‘Paths’) coincided with the DH deciding it should cease publishing such guidance in the spirit of ‘localism’. So, it languished on a quiet corner of a website only to subsequently disappear – along, sadly, with many other good practice materials that the DH previously resourced and promoted. Its ‘ownership’ has now been passed back to us. In the spirit of co-production it has been updated in partnership with people who use services, as well as service professionals, and is being launched today (April 24th) . Download the guidance on the right
The new Paths to Personalisation aims to contribute to overcoming the obstacles discussed above, by providing a whole-system framework and a tool for people and services to use to help make personalisation happen. It is a practical document, providing examples drawn from latest practice and policy and up-to-date sources of advice for people… and it is free…
Call me an optimist if you like, but maybe all this will help make choice, control, inclusion and recovery a reality for more people with mental health problems.