Personalised care in mental health
Personalisation has become a defining feature of adult social care services. Direct payments and personal budgets are set to become default methods of funding local authority care as they are believed to provide service users with enhanced choice and control over the services they use. This agenda has widespread support from organisations commissioning or providing social care services in the UK.
So far, the personalisation agenda has had minimal impact on mental health services. However, the Department of Health is committed to providing people living with enduring mental health problems increased choice and control over their health and social care services. For example, it is currently piloting personal health budgets for people with long-term health conditions. The pilot includes sites within mental health services and the final report of its evaluation will be published in October 2012.
A number of barriers exist to the full implementation of personalisation in mental health services including organisational cultures being unable to respond to new ways of working; concern about the management of risk which may constrain risk-taking in the context of increased choice and control over care; difficulties in disentangling ‘social care’ and ‘health’ needs to justify funding; or bureaucratic obstacles to setting up personal budgets or direct payments. Although all local authorities have met the performance target of having 30% of social care service users in receipt of a personal budget by April 2011, notional personal budgets have been used in some cases (particularly for mental health service users). This raises questions about the extent to which meaningful choice and control is being provided within the nomenclature of a personalised service.
In 2010 we set up a research group which brought together leading researchers, service users and carers to develop research proposals to investigate some of these issues. Facilitated by seedcorn funding by the NIHR Mental Health Research Network, this group has met on several occasions and has held two larger meetings with a range of stakeholders to develop a list of research priorities. These include personalised care in early intervention in psychosis; organisational culture change; brokerage; and the effect of personalised care on personal and social outcomes. Funding has just been confirmed for the first research proposal from the group and will commence in January 2012.
The group was successful with a bid for an NIHR Programme Development Grant on personalised care in mental health. This grant provides funding for a one-year project to investigate the feasibility of conducting a programme of studies to evaluate the effectiveness and cost-effectiveness of personalised care in mental health services. The work we will undertake in 2012 will have two components:
1) Practice survey and systematic reviews: Working in partnership with the Social Care Institute for Excellence and the Think Local Act Personal Partnership we will conduct a practice survey of mental health services to identify best practice in personalised care. We will also conduct systematic reviews of research on the outcomes of both the mechanisms (e.g. personal budgets and direct payments) and practice (e.g. self-directed support and empowering people to have more control over their care) of personalised care in mental health services.
2) Feasibility study for a randomised controlled trial: We will conduct semi-structured interviews with key informants to explore the feasibility of conducting one or more randomised controlled trials of aspects of personalised care to evaluate its effectiveness and cost-effectiveness.
On completion of this work, we aim to submit an application for an NIHR Programme Grant in 2013 which would provide funding for a five-year programme of studies. This programme would aim to produce high quality evidence to inform the implementation of personalised care in mental health services, including evidence about its effectiveness and cost-effectiveness.
This research project is a collaboration involving the following organisations:
We will be setting up a website shortly and will use this to engage practitioners, service users and carers in this research project as it develops. In the meantime, please do not hesitate to comment on this blog or contact me to exchange your views about personalised care in mental health.