Accessing Choice and Control in Mental Health Services Tina Coldham Health & Social Care Advisory Service HASCAS

Choice & Control Loaded term in mental health

What happens now Care Programme Approach Multi-disciplinary & Multi- agency approach to care Health bias?

Direct Payments Social Care £ April Legislation kicked in Feb 2001 to July 2003 – MH DP pilot April 2003 – Local Authorities 'required to offer' direct payments Performance Indicator March 2008 – 3,373 mental health service users on direct payments

Individual Budgets 13 pilot sites October 2008 – Evaluation report IB users were more likely to feel in control of their lives than people receiving conventional social care support Highest satisfaction amongst mental health service users. Significantly higher quality of life.

Choice Agenda in Health “From 1 st April 2008, choice has been made available to all patients requiring an elective referral. The majority of patients referred to see a specialist can choose where they will be treated.” Personal Health Budgets: first steps

Lynne Jones – Birmingham, Selly Oak, Labour, on 20/5/09 “To ask the Secretary of State for Health..., in respect of which elective mental health services patients have the right to choose the organisation that provides their treatment; and what account will be taken of advance statements in the provision of care for those detained under the Mental Health Act 1983 ?”

Phil Hope – Minister of State Care Services & East Midlands “The majority of patients, including those with mental health problems, are entitled to choose their provider when they are referred for their first consultant-led out-patient appointment. The right to choose does not extend beyond first out-patient appointment...”

Phil Hope – Minister of State Care Services & East Midlands Those detained under the Mental Health Act 1983 are excluded from the right to choice, but the code of practice to the Act specifies that “Decision makers must consider the patients views, wishes and feelings (whether expressed at the time or in advance), so far as they are reasonably ascertainable, and follow those wishes wherever practicable and consistent with the purpose of the decision.”

Personal Health Budgets “Personal health budgets can be used for any goods or services agreed as part of a care plan that are likely to meet the individual's agreed healthcare outcomes and would be appropriate for the state to fund.”

Personal Health Budgets “Good care planning should assess potential risks, and establish means to manage them. Early experimenters with personal health budgets recommend a realistic approach to risk management that does not create artificial barriers. Individuals should be supported to make informed decisions about taking and managing risks, including safeguarding risks.”

Positive Risk Management “Working with the person to identify what is likely to work; Paying attention to the views of carers and others when deciding a plan of action; Weighing up the potential benefits and harms of choosing on action over another;

Positive Risk Management Being willing to take a decision that involves an element of risk because the positive benefits outweigh the risk; Being clear to all involved about the potential benefits and the potential risks; and Developing plans and actions that support the positive potentials and priorities of the person while minimising the potential risks.”

The Guidance Best Practice in Managing Risk: Principles and evidence for best practice in the assessment and management of risk to self and others in mental health services. DH 2007

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