Crofts: Realizing the Promise of Self-Direction

NYAPRS Note: Note this timely new blog in Psych Services by Human Services Research Institute’s Bevin Crofts on groundbreaking advances in self-direction. The NYS Office of Mental Health is poised to roll out several Self-Directed Care pilots in the coming months.

Realizing the Promise of Self-Direction – International Perspectives

For the past two years, I’ve been a researcher on a Robert Wood Johnson Foundation-funded team examining self-direction in mental health. Last year, we brought together experts in self-direction and mental health from around the globe for a two-day, in-person ‘learning exchange’ as part of the 2015 International Initiative for Mental Health Leadership meetings.

All told, 45 participants, representing seven countries, attended the meeting, where we shared best practices, discussed challenges, and laid the groundwork for a learning community related to this growing practice. (If you’re not familiar with self-direction, check out the description below). Participants included government officials, researchers, policy experts, and administrators; and many—approximately one-fifth—self-identified as having lived experience of the mental health system.

I’m excited to announce that you can now read our description of the learning exchange; it’s available online ahead of print as “Open Forum: The Emergence of Mental Health Self-Direction – An International Learning Exchange” in the journal Psychiatric Services.

In addition to sharing a brief summary of studies to date, we provide some key considerations for self-direction—including the culture and systems change required to move toward a more holistic understanding of wellness and recovery, the training and support needed to ensure that people with lived experience are in leadership roles, and the need for both quantifiable outcomes and personal narratives to help stakeholders understand the value of self-direction.

It was heartening to hear stakeholders from diverse health and social service systems endorsing self-direction’s transformative potential. It was also interesting to learn that despite hailing from different system contexts with different stages of adoption and implementation, there were many shared barriers to progress, from thorny logistical issues to cultures that underestimate the decision-making capacity of people who use services. I hope we can find ways to continue the conversations that began last fall as our efforts continue to grow and evolve.

Self-Direction: Self-direction – also known as self-directed care, participant direction, personal health budgets – has emerged worldwide as a promising practice in mental health and as a means toward creating more person-centered service systems. In self-direction, service users control an individual and customized budget, using it to purchase from a range of goods and services that can help them achieve personal recovery goals.

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The Emergence of Mental Health Self-Direction: An International Learning Exchange

Bevin Croft, M.A., M.P.P., Kaipeng Wang, M.S.W., Benjamin Cichocki, Sc.D., C.R.C., Anne Weaver, M.A., L.M.H.C., Kevin Mahoney, Ph.D.

http://dx.doi.org/10.1176/appi.ps.201600014

Abstract

Self-direction has emerged worldwide as a promising practice for persons with serious mental health conditions and as a means toward creating more person-centered service systems.

In self-direction, service users control an individualized budget, purchasing goods or services that can help them achieve personal recovery goals.

This Open Forum describes an international learning exchange meeting, held in September 2015, in which experts in self-direction and mental health from seven nations convened for sharing best practices, discussing challenges, and laying the groundwork for a learning community to support the continued development of self-direction. Meeting participants identified three themes that represent next steps toward ensuring that the promise of self-direction is realized.

First, self-direction involves creating a culture shift for value-based systems change.

Second, people with lived experience must be involved and supported at every level, including direct support, leadership, and oversight.

Third, stakeholder communication about self-direction’s impact is critical.

http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201600014