Personal budgets for all? Implementing self-directed support in mental health services

Personal budgets provide people with more choice and control over how their needs are met and, allied to new thinking concerning individualisation of mental health care, are increasingly a feature of international governmental responses to long-term care. This study was based in an English National Health Service Health and Social Care Trust covering a large predominantly rural area. We aimed to develop self-directed support and understand more fully service-user and carer involvement in the process, using an action research design. Data collection took place between 2007 and 2011, and the project ran in three sequential spirals collecting qualitative data. Findings showed users and carers, and trust recovery coordinators acknowledged the need for cultural change, personal budgets’ effect on outcomes, and service-users’ capacity to manage these responsibilities. We conclude that moving to personal budgets can be empowering for mental health services users, but is problematic and may present challenges to service-users with fluctuating mental health. Recruiting service-users and carers to participate in research illuminates their otherwise-hidden perspectives, and our use of service-users as coresearchers is a process that others might want to emulate.