Nikki Bond, Research Assistant, Money and Mental Health

Balancing autonomy and risk - extending personal health budgets to people using mental health services

The government is consulting on a proposal to extend the legal right to a personal health budget to people who make regular and ongoing use of community based mental health services. This could be revolutionary for those it will effect and is a real move in the right direction, giving people more choice and control over the services they use to support their mental health and recovery.

Personal health budgets are currently widely used to provide people with illnesses or disabilities with packages of healthcare support that cannot be delivered by universal or specialist services. Extending this right to those under the care of community mental health services would involve a mental health clinician working with a person to assess their needs, identify outcomes they want to achieve, and agree upon a plan of how to get there. A sum of money (a personal health budget) is then agreed and allocated to meet these outcomes.

Increasing choice and control

Increasing the control, agency and choice people have over the services they use to support their mental health sounds like a great idea. Unsurprisingly, in a recent survey of 95 Research Community members who had been under the care of community mental health services in the last five years, we found that 90% wanted more choice and control over what services they were able to access to support their mental health and wellbeing.

The variety of services people wished to access was vast, and demonstrated how personal health budgets can make way for a more tailored and personalised approach than that offered by traditional mental health care models.

People told us how they would use the funds to meet their needs:

“I want to do voluntary work as the next step in my recovery. To do this, I need some support in getting a voluntary role and during the settling in period.”  

“A tablet via the health budget would be a good idea to reduce the feeling of isolation that often comes with depression.”

“Gym membership to help reduce huge weight gain due mostly to prescribed medications and enforced long periods of inactivity.”

Personal health budget funds can be managed in a number of ways, dependent upon a person’s needs and wishes. One method is through ‘direct payments’; where a person receives and manages the budget themselves, paying for the services identified in their care plan.

Power and responsibility

Whilst direct payments are the most autonomous payment method, they also come with the greatest degree of responsibility for managing the budget and purchasing services. Given the link between experiencing mental health problems and challenges with managing finances, it is understandable that both professionals and the people they serve may be somewhat cautious about embracing direct payments. However, there is strong evidence of the effectiveness of direct payments for people experiencing mental health problems, and additional benefits of empowerment, choice and control. The provision of direct payments is an opportunity for health, government and financial services to work together to support people to have as much choice and control over their care as personal preference and clinical need allow.

Creating safety nets

Careful planning and guided support at the outset of a personal health budget can ensure that budgets are set up with appropriate safety nets in place. In establishing direct payments, clinicians can support people to choose the most suitable bank account for payments, and one which allows certain financial tools to help a person manage. These may include:

  • A cooling off period for large payments, offering reassurance to the account holder and preventing impulsive spending that can be part of certain conditions
  • Ring fencing of funds, for example ensuring money for weekly counselling is separated from exercise or art therapy class funds
  • Ability to temporarily freeze payment cards, making a safety net for people with fluctuating health needs, who may need additional support with managing their funds at different times.

Extending personal health budgets and direct payments requires a significant shift in attitudes from both professionals and those in receipt of services. It’s not an easy change, but the benefits the research suggests that it can bring – supporting and empowering people, increasing their choice, control and agency – must certainly be worth it.