- Hospitals and healthcare
- Long-term conditions
- End of life care
- Learning disabilities and autism
- Mental health
What do Individual Service Funds look like in mental health?
Personal budgets, Individual Service Funds (ISFs) and self-directed support are becoming more commonplace in social care. However, there are questions raised and assumptions made about how they could work in mental health services.
Here are some of the issues raised by staff:
- People with complex needs and chaotic lives will be unable or unwilling to handle the increased choice and control.
- People won’t know how to purchase external support and will waste the cash allocation on drugs, alcohol or gambling.
- If people choose to purchase something that makes them feel good, such as a haircut, this is somehow not real support (echoing the sentiment that the medicine has to taste bad to do any good).
- People might become too “difficult”; for example, making impossible demands on staff to come into work at short notice.
- It would be too risky, with people putting themselves in danger of hurting themselves or others.
- People would be taken advantage of by others, and traditional safeguarding measures might not work.
- It would increase work for staff at a time of reduced staffing levels, and possibly destabilise the service.
- There could not be any meaningful customer control over resources in an accommodation-based support service, as most of the costs are taken up by salaries.
One provider, Look Ahead Housing and Care, believed they could overcome these challenges with person-centred practices. They began to make these changes by thinking about their block contract very differently, and developing a new model for giving people choice and control through a version of an ISF.
One way to have a personal budget is through an ISF, where a chosen provider uses your budget on your behalf in the way that you specify.
In the early days, Look Ahead Housing and Care and the London Borough of Tower Hamlets worked in partnership to trial an approach to people having a budget and staff hours. The contract is still a block contract, but control is devolved to the customer. The Coventry Road service in Tower Hamlets is described as a ‘high needs mental health accommodation-based service that has self-contained flats for twenty people’. All customers have a range of complex needs, including ongoing substance misuse, gambling addictions and forensic histories, and are subject to the Care Programme Approach (CPA).
Look Ahead developed an approach called a ‘core and flexi model.’ The ‘core’ refers to the fixed range of support required by everyone in order to run the accommodation-based service, while the ‘flexi’ refers to individual support that enables people to use their staff time in a personalised and flexible way. What is significant about this approach is that it isn’t limited to those eligible for social care funding, or to any particular kind of service. They are therefore setting out a way of individualising services, regardless of funding stream or service.
The pilot approached the money using the established principles of clarity and control around using personal budgets: people should know from the start how much money they can spend on their support; people should be clear about what outcomes must be achieved with the money; and people should be able to spend their money in ways and at times that make sense to them.
At the beginning of the project, 50% of people said that their key worker was the main decision maker in their lives. Eight months later, nobody thought that their key worker was the primary decision maker, showing a positive shift in power between staff and customers.
In this project, people were given the opportunity to have a facilitated person-centred review that formed the basis of their support plan, including generating the outcomes that the person then used their budget and additional key worker time to achieve. You can read more about Individual Service Funds in this ISF book.
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