Personalised Mental Health Services.The Stockport Experience

Carmel Bailey, Social Care Lead, Stockport Borough, Pennine Care

NHS TrustBarry Tildsley Prevention &

Personalisation Lead

The Journey begins…..

• Under-funded services

• Low morale

• Acute service cost and few alternatives to admission

• Traditional psychiatric service

• Risk averse practice

• User and carer dissatisfaction

The Stockport SDS Pilot• February 2009- September 2010, using

a ‘pure model’ of self directed support ( In Control)

• Target group- people on CPA receiving care coordination

• 160 in the first 12 months• 63 different staff proactively involved• User Led Organisation now support

planning

0 5 10 15 20 25 30 35 40 45

OtherWellnessDays out

Sports activitiesStudying / educationHome improvements

Support in social activitiesComputing equipment

TransportPersonal assistant

Domestic helpGym membership

Leisure activitiesTBA

Holiday / short breakSupport worker

External EvaluationThe Centre For Welfare Reform

“The University of Chester's report on the use of self directed support in mental health services is one of the most detailed and helpful accounts of how personalisation is working in practice.”

Rethink The PEOPLE Study

What were the challenges

• Actively engaging people• Culture change- perceived threat to the Clinical

Model• SAQ and RAS accuracy• Budget Sufficiency- unmet and newly found need• Validity of Choices• Evidence of Outcomes• Risk Taking• Capacity- running dual processes

• Overwhelmingly positive about SDS

Support plans creative and outcome focussed

Promoted Recovery

Achieving greater community involvement

Moving towards achieving inspirations

Having a purpose in life.

Including Families and Carers

• We have included a carers section within the Resource Allocation System (RAS)

• Each domain or area of need has an area that details the carer’s support for that area.

• All ,Most, Some, None

• The areas ticked generate an income

Involving Families In Supporting Mental Health Recovery

Family Support Plan ExampleThe Bolton family completed the Supported Assessment Questionnaire (SAQ) with their Care Coordinator. Their results from the assessment were imputed into the Resource Allocation System (RAS).

• Their Indicative Budget (IB) is £3,601.00 to £3,900.00

• However, within the Stockport (RAS) the carers are recognised for their contribution and were awarded funds to support their needs.

When support planning service users and their carers are asked to consider the following:•About me?•What's important to me?•What do I want to change? •My Budget?•How will I manage my support?•Outcome?

About me• My name is Janet, I am 22yrs old, the oldest of three and I am a

student.

• I suffer from Bipolar which means I go through stages of being ‘manic’ where I get over-excited and don’t think of the consequences.

• I have stages of being low which means I don’t have motivation and feel frightened and upset.

• I also suffer from Agoraphobia which means that I am afraid of leaving the house or going to unfamiliar places.

• I have family support/help regarding all my decisions to make sure my bipolar is not taking over.

• I need medication to keep me steady though it makes me tired.

• I need family support just to get me motivated and cannot leave my home without someone accompanying me.

About us

• We are Paul & Lucy (Janet's parents) and would like to express our sincere thanks and relief for this budget.

• We are parents of four children.

• All are children are students and Paul is also studying part time for a MA.

• Although we are keen to support Janet, it has been an intense time.

• We are a close family and we all contribute to support Janet.

What’s important to me?

• My family.• My pets.• My friends.• My studies. • My independence.• Getting Better!!!

What do I want to change?• The most important thing for me to change is my anxiety and the things

it prohibits me from doing.

• I would love to be in a position where I can freely go to appointments, see friends and go to the shops on my own.

• The main thing I feel will help me achieve this is the ability to drive. I recently got a provisional driving licence and hope to start lessons.

• What I would like to do is to use this opportunity towards driving lessons, test prices and use some of the money towards the insurance of a car so that I can enjoy more independence and freedom.

• If I had a car I could drive, I could leave the house with the knowledge that at any time I could choose to get back in the car and drive home of my own accord. This would be amazing to me and I think that just knowing that I had this ‘escape route’ made possible, it would give me the confidence to challenge myself to go out.

What we want to change

• We do not want to change Janet!

• She is beautiful, fantastically funny, witty and a entertaining person. She has lots of interests, and is great company.

• However, it would be wonderful if she could begin to enjoy her life and feel more fulfilled. We believe she will achieve this by becoming more independent, which in turn will allow us considerable respite.

My budget• Driving lessons

• Motorway lessons

• Going out for a coffee

• Sat Nav

• Driving test costs Theory & Practical test

• Car insurance (half cost)

• TOTAL £1,958.50

Our budget

• Annual petrol cost to transport Janet to university in York

• Cost towards the car insurance

• Petrol costs to godmother and friends

• Our budget = £1,222.80 +

• My budget £1,958.50 =

• Total budget £3,181.30 (Actual)

FROM INDICATIVE BUDGET OF £3,601.00 ---- £3,900.00

• Contingency £718.70**

How will I manage my budget?• My dad and I have opened a joint bank account so we can both

see what is coming in and out of the account. Neither of us can withdraw the money without the other so he and my mum will be able to make sure I am making balanced decision and am not having ‘a bipolar moment’ with my spending.

• We both use online banking and banking ‘apps’ to monitor the spending.

• I am allowed to be insured on my mum’s car for extra driving practice so this might reduce some costs.

• I agree and have signed the contractual agreement with Stockport Metropolitan Borough Council.

• We will receive bank statements and keep receipts. I have been made aware of the audit review requirements.

Outcomes(Hopes & Aspirations)

• Janet; I hope that the things I spend my SDS money on will allow me a greater level of independence in my life. I really hope that by slowly taking steps to go out more for simple things such as coffees and errands I will be able to think about doing volunteer work, not only towards my career but for personal enjoyment and maybe a part time job, while I am still at university, then looking forward to when I can have a career!!!

• Family; It will be our biggest challenge as a family to help Janet break free and embrace life again. We desperately want to see her rebuild a life and to do this she needs to go out in the world and meet people and make new friends. We believe the support and opportunity you are offering could be of vital importance in supporting this process.

WHAT FAMILIES HAVE PURCHASED

SHORT BREAKS EDUCATION SOCIAL MEDIA MEALS OUT

HEALTH & BEAUTY LEISURE PERSONAL ASSISTANT TRANSPORT

Family Outcomes

• Having massages has helped improve my mental well being greatly. The improvements made to my garden have improved the quality time I spend with my children which has improved my self esteem as I feel I am now a good mother.’

• ‘I am able to use my computer to look up face book and other social networking sites without relying on anyone else.’

• ‘It has given me more control + choice, by enabling me to choose the right care + support, + things which help to support me. It has given me more independence.’

• ‘Distraction from feeling unwell makes such a difference. I would like to thank you for helping me to get out of the house more. The personal budget has enabled me to do leisure activities with my daughters. This has made a big difference to me and how I feel about everything.’

• ‘SDS makes a big difference - that’s special. Thank you.’

Difficulties

Value base paying family

for looking after their own family

members.

More money orientated and

outcome focussed.

Focussing on the item not the outcome.

Recognition from families that there

needs to be a measurable outcome.

It isn’t for life, it’s a helping hand.

Expectations and creating

dependency.

Pooling budgets RAS not developed

in all services or holding onto their piece of the pie.

Restrictive practice, only able to purchase certain

goods.

Involving Families In Supporting Mental Health Recovery

Questions ? Thoughts