This blog is concerned with facilitating discussion at an upcoming EVOC ThinkSpace event to consider mental health services in the community, that is, with the content and structure of services rather than any design context. The Wayfinder Project has been initiated to re-design mental health services in light of the NHS Lothian programme to modernise (inter alia) the REH site. Alongside the need to re-construct the hospital site various policy drivers feed in.
Wayfinder forms a part of a larger process of build and service re-design conducted under the rubric of Public Social Partnership – a fairly new means to develop stronger partner relations and co-produce (ie all stakeholders jointly plan and deliver) services more suited to contemporary conditions and changing priorities.
Policy drives to reform the public sector also guide steps to re-shape mental health services, with the intention that services will become tailored to the individual, and will enable and support independent living (as far as possible).
To do so legislation has been enacted (SDS Act Scotland) which places a duty on providers to take regard of personalisation, and self-directed support in particular. While this has been under development much has been made also of introducing a human rights based approach to care services.
This blog takes elements of a Centre for Welfare Reform paper ‘Personalisation in Mental Health’ by Simon Duffy to outline the more significant issues in designing voluntary sector services (public sector services are dealt with elsewhere in partnership arrangements and face a distinct set of challenges), which put the principles and values of personalisation into practice and place the individual at the centre. Service provision has to change in this new environment in ways that embed changed relationships, the main features of which are that the individual will take control, make choices and achieve self-defined outcomes (within the parameters of available resources).
This summary describes some of the rhetoric of personalisation, while the following points to themes and issues in putting that into practice. A further paper will follow shortly looking at a rights based approach, to complement the aims and objectives of the personalisation agenda.
In A Sense of Belonging there is “a commitment to change”. The proposals for change range across the spectrum of specialist services, feature recommendations around mainstream services and reflect the principles and values of personalisation.
The remainder of this blog borrows heavily from the paper ‘Personalisation in Mental Health’ by Simon Duffy and published by The Centre for Welfare Reform (with others) as it offers a comprehensive overview of issues and possible actions.
Anyone with a passing knowledge of personalisation and mental health can recognise that care and treatments delivered across the system conform to distinct models, largely corresponding to setting, profession and sector. The challenge is to integrate services and aspects of the system so that those models and interests bend to the achievement of personally defined outcomes.
A personalised system will contain the following features (from Duffy):
- Support and services tailored to fit the specific needs of the individual
- Respect for the value of relationships the person may have with friends and family
- People take more control over their lives and supports
- People define the outcomes that matter to them
- Services and supports are more responsive and flexible
- More community involvement and for all stakeholders
To consist with broader public service reforms a different relationship between people and public and voluntary services is required. Such a new relationship builds on the capacities of individuals, networks and communities. For this reason commissioning will focus on achieving valued outcomes, by the most efficient means. To move toward this goal the expertise of people who make use of services constitutes an invaluable resource.
However complex that may appear to implement it represents one example of a fundamental aspect of personalisation – the value of the person over the needs of the system and the shifts in behaviours required of its adherents.
In addition to individual assets holistic resources within, for and by communities take on importance. Some questions are what resources are required, how might these resources be shaped and/or rendered accessible, and is there sufficient flexibility (particularly when needs fluctuate) and responsiveness?
Duffy lays out useful design principles for a personalisation model:
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The new model must work for citizens and their families, in particular |
But this model must also work for statutory partners and for the community as a whole:
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CEC Health and Social Care Dept has published its Market Shaping Strategy – an overarching local authority commissioning strategy for adult health and social care services. The strategy recognises the role and value of preventive services on a number of levels, not least in support of the personalisation agenda. Indeed the direction taken by Health and Social Care Department consists remarkably with Sense of Belonging in many respects (despite the introduction of payment at the point of delivery and spend on acute, medical services!!).
These services, designed to support individuals achieve their outcomes, may be grouped around function and purpose. The following is not intended as a comprehensive list of all that needs to be on offer, nor all that providers do e.g. it does not elaborate on the diversity of specialist services :
- recognising social and economic factors – actions which address the social and economic conditions of inequality, promote social justice and equal access; good quality housing and housing with support
- promote well-being – a public health approach to mental health; actions which support greater awareness, social networks, a greater sense of agency and informal mutual support; information and advice; advocacy; independent brokerage
- early intervention – targeted support and services to those at particular risk of poor health eg people who have experienced violence and abuse, sections of BME communities
- avoid escalation – services and supports available at appropriate times to maintain well-being even as needs may change; specialist services; crisis centre
In line with the intention to utilise generic community services Health and Social Care Dept commissioning is moving toward geography alongside traditional client groups – the city is taken as four quadrants and contract bundles will reflect geographic and themed needs. In designing services now taking heed of and giving some priority to community capacity and resilience ie to community development, ensures the design and operations are future proofed.
As of 1 April 2014 SDS ‘goes live’. The people currently about to leave the hospital may well be eligible and have choices to make about how to organise their support. At the moment any calculations around the scope and nature of services have to take into account our best predictions of personal outcomes and to adapt to ensure gaps are filled. While there may be challenges there comes scope for innovation – to develop new services eg independent brokerage, opportunities for creative expression or to suit the use of pooled budgets; and to exploit the potential of current and emerging digital technologies.
For some agencies there are many advantages arising from reforms and for others choosing an appropriate business model presents challenges to their ethos and capacity – yet all have a part to play and a role in designing and delivering care.
Our task is to begin to describe services (and thus a system) which offer(s) choice and control that voluntary sector providers can deliver in this new environment.
BIBLIOGRAPHY
Much of the above has been lifted from here (with many thanks!):
https://www.centreforwelfarereform.org/uploads/attachment/233/personalisationinmentalhealth.pdf
Other very useful sources of info can be found on the Mental Health Foundation site:
https://www.mentalhealth.org.uk/publications/choice-control-recovery/
the MHF also has published papers on mental health and Self-Directed Support.
The National Development Team for Inclusion have published findings:
https://www.ndti.org.uk/uploads/files/Untitled001.pdf offers a cautionary note as well as papers on self-directed support and mental health by Rich Watts.
The literature on personalisation and mental health mostly focuses on self-directed support. Searching for information to write a blog there was very little which related directly to mental health rehab and service re-design across the system from a personalisation angle – another indication of the gap between the rhetoric around process and policy intent, and experience on the ground for people.
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