Personalisation & Recovery Pathways In Mental Health Services. The Stockport Experience

1. Personalisation & Recovery Pathways In Mental Health Services. The Stockport Experience Preston September 12th 2012 Nick Dixon Commissioner Mental Health Carmel Bailey, Social Care Lead, Stockport Borough, Pennine Care NHS Trust

2. Delivering Personalised Care Packages Within Stockport Mental Health Services • How we began • What we have learnt • What worked • Risks • What we would do differently • Discussion

3. Local Story • Resources in acute care not prevention, in statutory services not community sector and in secondary care not primary care • Weighting to mental illness not mental health • Length of stay in secondary care • Little focus on outcomes • Need to deliver on Personalisation- choice and control • Need to reduce dependency on public services • Culture Change perceived to be critical

4. Values and Culture • Values Based Awareness alongside Evidence Based Practice • Balancing the medical, psychological and social approaches • Support and motivation as well as care and safety • Focus on strengths and assets as well as problems and deficits • See the person beyond the patient- citizenship not exclusion • Prioritise Recovery over maintenance v

5. Times are changing in mental health Traditional interactions Expert knowledge creates behaviour change Goals are set by the clinician and success is measured by compliance with them Decisions are made by the clinician. Collaborative interactions Belief that change can happen, together with knowledge, leads to behaviour change Person is supported in defining their own goals. Success is measured by attaining those goals Decisions are made as a service user-clinician partnership Power with clinicians Co-production-power shared

6. Stockport Mental Health SDS • Began with pilot in February 2009- 18 months, now embedded as core offer • 94 in the first 12 months, currently 384 • 86 applications to the Recovery Budget in pilot (average payment £300) • Recognised limitations of SAQ and RAS- now have one which feels right • Brokerage- User Led Organisation now support planning • Developed on line Market Place • http://www.mycaremychoice.org.uk/homepage.aspx

7. Personal Budgets have shown how differently people might do things • Buying a dog • Purchase of a mobile phone/artists materials • Driving lessons/buying a car • Playing in a violin group • Employing personal assistants during crisis to avoid hospital admission • Joining a dating agency • Hiring an art teacher • Belly dancing • Participating and running an independent leisure, sport and social group • Paying for travelling to stay with relative for a break

8. What was money spent on?

9. Number of Service Users / Average Spend

10. What We Have Learnt • From external research and our own reviews and evaluation • Views of people using services • Practitioners’ perspective

11. External Evaluation : “The University of Chester's report on the use of self-directed support in mental health services is one of the most detailed and helpful accounts of how personalisation is working in practice.” http://www.centreforwelfarereform.org/library/categories/commissioning-brokerage http://www.stockport.gov.uk/2013/2996/41105/stockselfdiretsupportpilotmentalhealth Rethink: Interim Summary Site Report The PEOPLE Study Phase1 Stockport Metropolitan Borough Council The University of Birmingham and Kings College London ( Not for public distribution as yet) SMBC and Pennine Care Internal Reviews 2010,2011,2012

12. What do service users say? Overwhelmingly positive about SDS Support plans creative and outcome focussed Promoted Recovery Achieving greater community involvement Moving towards achieving inspirations Having a purpose in life.

13. Some frustrations along the way Lack of clarity over process, eg where to get information. Better guidance as to what could be included in plans Time taken to complete application

14. Practitioner experiences Generally felt SDS was a positive development in mental health services BUT More targeted, practical and ongoing training needed, and better communication Time pressures More acknowledgement of current skills Must address perceived inequity, gate keeping Support for risk taking practice needed

15. Someof the challenges! • Culture change- perceived threat to the Clinical Model • SAQ and RAS accuracy • Budget Sufficiency- unmet and newly found need • Validity of Choices • Evidence of Outcomes • Risk Taking • Capacity- running dual processes • SDS being seen as a process • Clinicians not referring to peer services

16. Levers for Change • Director leadership- a ‘must do’ • Senior People actively supporting the strategy • Willingness to take risks- legal assurance necessary • Engagement with values and broader recovery agenda • Narrative evidence persuasive • Recovery Budget - key tool for culture change

17. Wider Learning • Ensure SDS is core business of FT, not an add on • Structures are key- training, surgeries, core group, project board • Address fear of blame and accountability- balance risk • Avoid focus on ‘the what’ but do focus on ‘the why’ • Develop tool to link needs and outcomes- robust reviews • Focussing on the larger picture and pathways through service

18. Some Risks • The ‘professionalising’ of personalisation • Personal budgets used to support a ‘maintenance’ approach • Limited and reducing budget, new demand • Recovery and self management not prioritised

19. For the future: • Integrate with CPA - eg Wellbeing Care Plans • Develop an information bank, the market place and community based circles of support. • Reviewing packages outside of Statutory Services • Peer Support & review • Meeting on going need within the community, Time Banks

20. Thank you for listening Questions and discussion nick.dixon@stockport.gov.uk carmel.bailey@nhs.net