Self-Directed Support in mental health: what can you do differently?

Permission to DreamBelow is a post written for Outside the Box in Scotland, ahead of their Permission to Dream event next month on how people across Scotland have been getting on over the first year of Self-Directed Support.

Last year, Outside the Box ran a series of great events on what the new Self-Directed Support Act (2014) might mean for mental health in Scotland. The events brought together a range of people from across the mental health system: people who use services, families, carers and representative organisations; social workers; team managers; commissioners and providers. As a result, the conversations were rich and engaging.

One thing that struck me during people’s discussions was that very few people thought the health and social care system was working for people with mental health problems as it was. This feeling wasn’t limited to just social care outcomes and people’s mental health themselves: it included what opportunities people with mental health problems had in areas of life like housing, employment and fairly accessing welfare support.

The question before everyone was clear: how do we make things better? The Self-Directed Support Act 2014 is a major part of the answer. The Act aims to empower people to have control and responsibility over how their care and support is arranged, including offering people different choices for organising their care. (You can find out more information about the Act on the Getting There website.)

Henry Ford famously said: “If you always do what you’ve always done, you’ll always get what you’ve always got.” The Act is therefore a really good chance to do something differently. A really interesting question for everyone with an interest in the mental health system to ask themselves is: what can they do differently as a result of the new SDS Act?

Here are a few suggestions (you can find more in this practice paper on the Getting There website):

  • For people who use services, this could mean finding out more about the Self-Directed Support Act so you know what your rights are and how to access the support available to live the life you want.
  • For a frontline practitioner, this could mean working in partnership with a person rather than thinking of them as someone to assess and put in place a package for. This could include thinking together beyond the usual menu of ‘traditional’ services people might access.
  • For team managers, it could mean creating regular opportunities for their team members to talk about the good things they’ve done as a result of self-directed support, or to talk about the challenges this new way of working brings and enabling people to support each other to address those challenges.
  • For people who commission services, it could mean knowing how much money was spent on what types of mental health support and then explicitly aiming to change this over the next 3 years, responding to the different choices that people make.

The pressure and constraints that currently exist in the mental health system sometimes lead people to think they can’t do anything themselves to make things better – it’s “beyond their control”. The places that make the most progress are those where as many people as possible take the opportunity to do something different in their part of the system and give it a go – no matter how small a change they personally make. Let’s all of us use the opportunity of the Self-Directed Support Act to help improve the lives of people with mental health problems.

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Personalisation and funding cuts

This is a really neat way of putting things when it comes to personalisation and funding cuts:

Although the implementation of Self-Directed Support will be affected by funding cuts, personalisation brings challenges regardless of the financial context; cuts bring challenges regardless of the model of social care.

From IRISS’s insight on Self-Directed Support: preparing for delivery.

It’s an important observation, and we should always be careful not to conflate personalisation and funding cuts – either as commissioners or as campaigners.

I would walk 500 miles… Visiting #dpulo in Scotland

After my visit to Wales, I made the enjoyable 12-hour round trip to Edinburgh to meet with a range of Scottish Disabled People’s User-Led Organisations.

(I say it was an “enjoyable” trip because I had some excellent books to keep me company, alongside the usual work stuff. I’d recommend Justice by Michael Sandel and The Righteous Mind by Jonathan Haidt. Ill Fares the  by Tony Judt was fine and, though I agree with its diagnosis, I’m not so sure about the symptoms it identifies nor the remedies it recommends.)

It has been some 5 years since I last worked in the disability scene in Scotland through the Scottish office of the Disability Rights Commission, so I was looking forward to hearing about the current set of issues DPULOs face.

And there are certainly lots that gave me food for thought. Alongside the ones we might normally associate with disabled people’s organisations and the voluntary sector (funding, governance, communications, impairment “versus” pan-impairment, infrastructure) there were some issues specific to Scotland, too.

The ones I was particularly left with were:

  • The significant rurality of Scotland. I heard tales of three-day roundtrips for a 2-hour meeting and the associated complexities of working across 32 local authorities
  • The challenge of two significant pieces of legislation traveling through the Scottish parliament at the same time – one on Self-Directed Support in social care and another on Health and Social Care integration – and how they do (or don’t) join up and what this means for DPULOs looking to develop services for commissioners and individuals to buy
  • The particular relevance of big “P” Politics and its more pronounced impact on decision making, particularly in commissioning and procurement.

At the same time, though, I came away from a meeting with around 20 disabled people’s organisations feeling inspired and optimistic about the future in Scotland. There are some fantastic people there doing some great stuff, and the Scottish Government feels to have acknowledged some of the more pressing issues. (This includes, for example, through the work of Independent Living in Scotland and Self-Directed Support Scotland to name but two of very many excellent organisations).

As with Wales, so it will be fascinating to see how Scottish DPULOs individually and collectively respond to the challenges and opportunities that exist at the moment and over the coming years.

Thanks to Lothian CIL for hosting the visit and for the contributions of everyone who was involved. I shall look forward to a chance to learn more on a further visit towards the end of July.