Government plans for personal health budgets don’t go far enough

Personal health budgets (PHBs) can be a valuable tool for handing people control over their own healthcare – allowing people to pay for therapies, care or activities that support their recovery. This personalised approach to care has long been used successfully for people with complex physical health needs.

Last summer, the government consulted on extending the legal right to a PHB to other groups of people. That included people discharged from a mental health hospital following compulsory admission, who are eligible for aftercare services (sometimes known as Section 117 aftercare services), and those with ongoing mental health needs who make regular and ongoing use of community-based NHS mental health services.

As part of our response to the government consultation, we surveyed our Research Community and found that people with lived experience of mental health problems wanted more choice and control over the services they use to support their mental health needs and recovery. 

The good news

We were therefore delighted that in its response to the consultation (published earlier in the year), the government decided to introduce PHBs for people discharged from hospital following compulsory admission for a mental health condition. This demonstrates their recognition of the diversity of people’s needs for recovery or management of long term mental health conditions, and will go far in supporting people to be creative in the services they use to aid their recovery. 

“A choice of what type of counselling would have helped. I was forced to choose between two types. I could only see the psychiatrist for a medication review if I went to CBT [Cognitive Behavioural Therapy] which wouldn’t help at this time. Budget for exercise would have made a big difference to my mental health and general wellbeing – more than a low-level CBT course that I’ve done before.” – Research Community member.

The less good news

However, we were disappointed that the government stopped short of extending the right to a PHB to people who make regular use of community-based NHS mental health services, instead committing to consult further on this. 

One complication they are grappling with is the question of how long a person should be using community-based mental health services, to entitle them to a PHB. A proposal being explored is that people should become entitled to a PHB after using community-based mental health services for a year. We are concerned that this does not go far enough in meeting the needs of people experiencing severe mental health problems. 

Instead, we think that the legal right to a PHB should be extended to include people who have had two or more episodes of care within a one year period. This goes further than existing proposals, but in doing so recognises that people’s mental health needs fluctuate. It would also make provisions for people who experience shorter periods of being acutely unwell and periods of more stable mental health, and who still require a more personalised approach to the services they can access to aid their recovery.

While we do not believe the one year preliminary proposal goes far enough, we are nonetheless encouraged by the government’s commitment to the time period being based on an individual’s circumstances, with any ‘significant time period’ acting as a discretionary guide. 

We look forward to seeing how the government’s plans for increasing PHB’s for people making regular use of community mental health services progress. These changes are central to the government’s wider work on increasing the personalisation of care. It is essential that people who regularly use community mental health services have as much choice and control over their care as other groups.

You can read our response to the government consultation on personal health budgets here.