Personalisation & Recovery Pathways In Mental Health Services.

The Stockport ExperiencePreston September 12th 2012

Nick Dixon Commissioner Mental Health

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

Delivering Personalised Care Packages Within Stockport

Mental Health Services• How we began• What we have learnt• What worked• Risks• What we would do differently• Discussion

Local Story

• Resources in acute care not prevention, in statutory services not community sector and in secondary care not primary care

• Weighting to mental illness not mental health• Length of stay in secondary care• Little focus on outcomes• Need to deliver on Personalisation- choice and

control• Need to reduce dependency on public services• Culture Change perceived to be critical

Values and Culture

v• Values Based Awareness alongside Evidence Based Practice

• Balancing the medical, psychological and social approaches

• Support and motivation as well as care and safety• Focus on strengths and assets as well as

problems and deficits• See the person beyond the patient- citizenship

not exclusion• Prioritise Recovery over maintenance

Times are changing in mental health

• Traditional interactions

• Expert knowledge creates behaviour change

• Goals are set by the clinician and success is measured by compliance with them

• Decisions are made by the clinician.

Collaborative interactions

Belief that change can happen, together with knowledge, leads to behaviour change

Person is supported in defining their own goals. Success is measured by attaining those goals

Decisions are made as a service user-clinician partnership

Power with clinicians Co-production-power shared

Stockport Mental Health SDS

• Began with pilot in February 2009- 18 months, now embedded as core offer

• 94 in the first 12 months, currently 384• 86 applications to the Recovery Budget in pilot

(average payment £300)• Recognised limitations of SAQ and RAS- now

have one which feels right• Brokerage- User Led Organisation now support

planning• Developed on line Market Place• http://www.mycaremychoice.org.uk/

homepage.aspx

Personal Budgets have shown how differently people might do things

Buying a dogPurchase of a mobile phone/artists materialsDriving lessons/buying a carPlaying in a violin groupEmploying personal assistants during crisis to avoid hospital admissionJoining a dating agencyHiring an art teacher Belly dancingParticipating and running an independent leisure, sport and social group Paying for travelling to stay with relative for a break

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

94£4 - 6 k

181£3k

343£2.8k

Year 1 Year 2 Year 3

What We Have Learnt

• From external research and our own reviews and evaluation

• Views of people using services• Practitioners’ perspective

“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.”

http://www.centreforwelfarereform.org/library/categories/commissioning-brokerage

http://www.stockport.gov.uk/2013/2996/41105/stockselfdiretsupportpilotmentalhealth

Rethink: Interim Summary Site Report The PEOPLE Study

Phase1 Stockport Metropolitan Borough CouncilThe University of Birmingham and Kings College London

( Not for public distribution as yet)SMBC and Pennine Care Internal Reviews 2010,2011,2012

External Evaluation :

• 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.

Some frustrations along the way

Lack of clarity over process, eg where to get information.

Better guidance as to what could be included in plans

Time taken to complete application

•Generally felt SDS was a positive development in mental health services BUT

– More targeted, practical and ongoing training needed, and better communication

– Time pressures

– More acknowledgement of current skills

– Must address perceived inequity, gate keeping

– Support for risk taking practice needed

Some of the challenges!

• 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

• SDS being seen as a process

• Clinicians not referring to peer services

Levers for Change

• Director leadership- a ‘must do’

• Senior People actively supporting the strategy

• Willingness to take risks- legal assurance necessary

• Engagement with values and broader recovery agenda

• Narrative evidence persuasive

• Recovery Budget - key tool for culture change

Wider Learning• Ensure SDS is core business of FT, not an add on• Structures are key- training, surgeries, core group,

project board• Address fear of blame and accountability- balance

risk• Avoid focus on ‘the what’ but do focus on ‘the

why’• Develop tool to link needs and outcomes- robust

reviews• Focussing on the larger picture and pathways

through service

Some Risks• The ‘professionalising’ of personalisation

• Personal budgets used to support a ‘maintenance’ approach

• Limited and reducing budget, new demand

• Recovery and self management not prioritised

For the future:

• Integrate with CPA - eg Wellbeing Care Plans

• Develop an information bank, the market place and community based circles of support.

• Reviewing packages outside of Statutory Services

• Peer Support & review• Meeting on going need within the

community, Time Banks

Thank you for listening

Questions and discussion

nick.dixon@stockport.gov.ukcarmel.bailey@nhs.net