Personal Budgets for all? An Action Research Study on Implementing Self-Directed Support in Mental Health Services

Abstract

Background: The recent political agenda for health and social care requires more client-centred, personalised services. Self-Directed Support, encompassing Direct Payments and Personal Budgets, is designed to provide people with more choice and control over how their needs and outcomes are met. Personal budgets are available for eligible people however take-up is low in mental health services. Research Aims: The study was set in an NHS Health and Social care Trust covering a large predominantly rural area.The aims of this study were: (1) to develop Self-Directed Support within one mental health Trust and; (2) understand more fully service user and carer involvement in the process. Methods: This study used action research incorporating: a spiral methodological framework; a project steering group; and service user and carer co-researchers. Data collection took place between 2007 and 2011, and the project ran in three sequential spirals using qualitative methods to triangulate the findings and identify any divergence in data. Findings: Findings showed that organisational language, structures and power relations provide barriers to effective involvement of service users and carers. Action research is very relevant for researching projects involving transformational change in health and social care, and including service user and carer co-researchers adds rich and authentic data. Findings concerning Self-Directed Support concluded that it afforded people more choice, flexibility and control than previous policy, and an improved quality of life. Concerns about bureaucratic processes, lack of information and knowledge of Self-Directed Supportwere found. Workforce concerns about safety of service users under Self-Directed Support and cultural shifts to more democratic methods of working were reported. Conclusions: This study's results correspond closely with national studies: staff attitudes and culture need changing to empower people to take up Self-directed Support. Concerns about quality assurance and safety are prevalent. Mental health services pose additional obstacles in their structures and reliance on the medical model. Social care knowledge cannot be assumed for all mental health Trust practitioners.