![7027596629_1b17209fa6_z](https://www.nationalelfservice.net/cms/wp-content/uploads/2015/12/7027596629_1b17209fa6_z-150x150.jpg)
This paper reports on research exploring how people with enduring mental health problems are affected by personal budgets.
The authors begin by rehearsing debates about whether personalisation is aimed to increase choice and control, or is more focused on increasing market forces and consumerism. This debate is located within different understandings of power. Under the dominant neoliberal world view, power is seen as a commodity, which can be transferred from professionals to people with mental health problems.
Hamilton et al propose a more subtle view of power, seeing it as arising through relationships. Such a view is said to support people with mental health problems and professionals working together to improve social wellbeing as opposed to professionals being constructed as experts who know best. Hamilton et al also acknowledge the evidence of the benefit of personal budgets, particularly in the form of direct payments, in increasing choice and control.
The rationale for Hamilton et al’s research, on which the paper is based, is that there is little in-depth research investigating the impact of personal budgets on people with severe and enduring mental health problems.
![This paper reports on research exploring how people with enduring mental health problems are affected by personal budgets](https://www.nationalelfservice.net/cms/wp-content/uploads/2015/12/14337857415_9cf37ebc4a_z-300x225.jpg)
This study looks into how people with enduring mental health problems are affected by personal budgets
Method
The research took place in three local authority areas, selected to cover different geographic areas, urban/rural status and levels of personal budget take-up.
The article reports findings from semi-structured interviews (recorded with permission) with 52 service users with mental health problems and 28 mental health practitioners undertaken in 2012-13.
Information on the characteristics of participants is provided, which is useful and the research methods and approach to analysis appear to be appropriate.
Findings
Four overarching themes were identified, one of which was divided into three sub themes:
Attitudes and values
- Attitudes and values are seen to be central in constructing the meaning of choice and control for people with mental health problems.
- Most service users indicated they felt grateful for receiving the personal budget, which led to a reluctance to negotiate over the amount offered. This was opposed to regarding this option as a right.
- Some practitioners felt more comfortable if service users were grateful for the opportunity. Hamilton et al argue that this indicates practitioners’ unwillingness to let go of power.
![Some practitioners felt more comfortable if service users were grateful for the opportunity. Hamilton et al argue that this indicates practitioners’ unwillingness to let go of power.](https://www.nationalelfservice.net/cms/wp-content/uploads/2015/12/Screen-Shot-2015-12-17-at-9.31.13-300x196.png)
Some practitioners in the study felt more comfortable if service users were grateful for the opportunity. The authors say this indicates unwillingness to let go of power.
Perceptions of capacity impacting on the process and decision making
- Being offered the personal budget when service users were still very unwell or when capacity was limited, created a concern for professionals and service users about their ability to take on managing the budget.
- Support from peer organisations or family was felt by participants to be essential in successfully managing a personal budget, particularly where capacity fluctuated.
Power relations and orientations
Control as a transfer of responsibilities
- Many participants described taking on responsibility for each part of the process, assessment, support planning and advocating for the plan with social workers and managers. While this could be empowering for some, others found this somewhat of a burden.
Resistance to transfer of responsibilities
- Service users gave accounts of what seemed more like a passive approach to accepting the responsibilities of managing their personal budgets, rather than deliberate resistance. They reported a lack of interest in having control or that practitioners just took over and did not give them the chance.
- However, some social workers in the study believed that some long-term mental health service users and those who were still unwell were unwilling or unable to assume responsibility for managing the personal budget.
Choice as a shared and supported activity
- Most commonly, service user and professionals worked in partnership to make decisions about the use of the personal budget. This required a good relationship between practitioner and service user.
- However some service users rejected the partnership approach, reflecting a view that the Personal Budget was a right rather than a privilege.
- Furthermore, practitioners reported retaining an element of control if decisions were being made that they felt put the person at risk, or did not meet their needs in other ways.
Local authority approval
- After support plans have been agreed between service users and practitioners, the plan has to be approved by the local authority. Hamilton et al found that service users experienced this process as confusing and disempowering.
- Practitioners also reported feeling powerless over these decisions, although sometimes used this as a way of distancing themselves from responsibility for the decisions made.
![Most commonly, service user and professionals saw choice as a shared and supported activity](https://www.nationalelfservice.net/cms/wp-content/uploads/2015/10/shutterstock_243884815-300x200.jpg)
Most commonly, service user and professionals saw choice as a shared and supported activity
Conclusion
The authors conclude that
A key factor in enabling personal budgets to support empowerment and recovery was reported to be the quality and continuity of the professional relationship—which raises particular implications for the organisation of mental health social work and the organisational cultures within which this is situated.
Strengths and limitations
Hamilton et al acknowledge that the study was limited, partly because interviews had taken place in only three authorities, which are unlikely to be representative.
Also as local authorities are undergoing a more rapid than usual set of changes and reductions in their budgets, frequent changes of approach are required, increasing variability of practice.
It would have been extremely helpful if Hamilton et al had distinguished between comments related to managed personal budgets and direct payments. Very different experiences and outcomes of the two forms of personal budgets have been reported (Stevens et al, 2015; Slasberg et al 2014).
![The study was limited, partly due to interviews taken in only three authorities, which are unlikely to be representative](https://www.nationalelfservice.net/cms/wp-content/uploads/2015/08/shutterstock_158505446-300x218.jpg)
The study was limited, partly due to interviews taken in only three authorities, which are unlikely to be representative
Summing up
Hamilton et al point out that where people with mental health problems had been able to take control over their budgets, it offered more control over support for daily living and facilitated different routes to recovery, including supported employment. In general, service users, preferred to manage these processes in partnership with professionals, instead of going it alone.
However some practitioners were felt to have limited the increase in control, through approaches that continued old styles of exerting power over service users, rather than working in partnership.
Final decisions by local authorities to approve plans (or not) were made without direct input from service users; this was a clearer indication of the continuation of old power regimes.
Public spending cuts were also identified as restricting practitioners’ abilities to foster greater choice and control. Consequently, Hamilton et al argue that achieving choice and control is not only affected by practitioners’ attitudes and skill, but also organisational processes and culture.
Links
Primary link
Hamilton, S., Tew, J., Szymczynska, P., Clewett, N., Manthorpe, J., Larsen, J., and Pinfold, V. (2015) Power, Choice and Control: How Do Personal Budgets Affect the Experiences of People with Mental Health Problems and Their Relationships with Social Workers and Other Practitioners? British Journal of Social Work, 04/2015; DOI: 10.1093/bjsw/bcv023. [Abstract]
Other references
Slasberg, C., Beresford, P. and Schofield, P. (2012) ‘How self-directed support is failing to deliver personal budgets and personalisation’, Research, Policy and Planning 29(3), 161-177. [Full Text]
Stevens, M., Manthorpe, J., Hussein, S., Ismail, M., Woolham, J., Samsi, K., Baxter, K. & Aspinal, F. (2014) ‘Risk, Safeguarding and Personal Budgets: exploring relationships and identifying good practice’, London: NIHR School for Social Care Research. [Full Text]
@SocialCareElf @AMLTaylor66 Don’t know how much my budget is Needed crisis help recently & got told2 save my money in case needed it later
@SocialCareElf @DrEm_79 I wish I could write a paper about my exp. Impact of financial assessment. I can’t have budget can’t afford to pay
@Nuclearporridge @SocialCareElf I’m sorry, sounds awful. Budget pushed on me in place of NHS care, NHS saw it as excuse to stop providing tx
@DrEm_79 @SocialCareElf Budget offered to me instead of any MH services. I know financial assessment is wrong but no one will listen. TY
@Nuclearporridge @SocialCareElf so sorry. You’re not the only one that’s happened to. That’s how NHS MH here seem to see budgets too
@DrEm_79 @SocialCareElf its totally wrong & not ’empowering’ or giving ‘choice& independance’ as they claim to do its the opposite!
@Nuclearporridge @SocialCareElf do you have any support now?
@DrEm_79 @SocialCareElf none at all not even any CMHT apts haven’t for years. All they will offer is budget.
@Nuclearporridge @SocialCareElf that seems the opposite of the rhetoric, no choice and no care
@DrEm_79 @SocialCareElf That’s precisely it. Plus when I tried to challenge their calculation they tried saying I ‘have no care needs’
@Nuclearporridge @SocialCareElf :-(
@DrEm_79 @SocialCareElf they scrapped decision had to fight for years to get it reinstated. Now got ‘critical needs’ but no care
@Nuclearporridge @SocialCareElf awful. Seems like noone’s responsibility when it should be everyone’s?
@Nuclearporridge @SocialCareElf NHS saw budget in place of CMHT, but can’t buy consultant to prescribe, and social support can’t manage risk
@DrEm_79 @SocialCareElf I’m so glad you RT’d this. Can’t find much on topic. Its a postcode lottery on what councils charge
@DrEm_79 @SocialCareElf I would be financing it all myslef max contribution yet council dictating how I spend my own money crazy
@DrEm_79 @SocialCareElf if I were working I would pay nothing but all benefits taken into consideration. I wouldn’t be able to live
@Nuclearporridge @SocialCareElf seems so wrong. I’m sorry
@DrEm_79 @SocialCareElf thanks
@SocialCareElf @DrEm_79 for me it has been a very disempowering exp & damaging to MH. Cannot pay £166 04 pw for budget so no support
RT @SocialCareElf: Read @MartinStevens2 Mental health practitioner & service user perspectives on #PersonalBudgets https://t.co/ohrZOzu5M1
Blog on power relations between Mental health practitioner & service users re Personalisation #PersonalBudgets https://t.co/2n49dmXnmk
Morning @SCWRU Have you seen @MartinStevens2’s blog on your “Power, Choice and Control” BJSW paper? https://t.co/ohrZOzu5M1
Mental health practitioner and service user perspectives on personal budgets – @SocialCareElf from @MartinStevens2 https://t.co/IDI8Eesm3i
More alike than unalike? Service user & practitioner experience of #mentalhealth #personalbudgets https://t.co/SFJPa2YQXT @McPinFoundation
@MartinStevens2 finds out that choice should be a shared & supported activity in #personalbudgets for #mentalhealth https://t.co/lG1APoX8ri
RT SocialCareElf MartinStevens2 finds out that choice should be a shared & supported activity in #personalbudgets … https://t.co/Gw8ScVbBD5
The @SocialCareElf reviews a recent paper by our team on Personal Budgets, Power, Choice & control in Mental Health https://t.co/6VBr4SdJw0
Don’t miss: Power and powerlessness: Mental health and personal budgets https://t.co/ohrZOzu5M1 #EBP
@SocialCareElf Very interesting! Just writing summit about it
[…] 17th of December 2015 the Social Care Elf published a summary by Martin Stephens of the paper Power, Choice and Control: How Do Personal Budgets Affect the Experiences of People with Mental Heal…. The paper details ways patients with enduring mental health conditions in England, and the […]
[…] Mental health practitioner and service user perspectives on personal budgets – blog shared by the Social Care Elf […]
[…] 1Power relations and personal budgets in mental health- The Social Care Elf […]