person-centred support
Continuing barriers They saw person-centred support as seeing people as individuals and organising services and support around them, and not the other way around: “treating people how you would want to be treated” so that “the power is with the person, not the organisation.” Sadly, the study showed that the routine experience of many service users was often very different. In all services, including mental health, examples were routinely encountered of service users being denied their human rights and not having their needs met. Equally, even in times of cuts and difficulty, some services and practitioners emerged as working hard to overcome the kind of barriers that are still commonly encountered. These barriers included people being institutionalised in residential settings, feeling disempowered and isolated at home, often lacking transport, not allowed to do things for themselves, kept in poverty, dependent on family carers, constantly being ‘risk-assessed’ in risk averse settings, with service users and carers from black and minority ethnic communities having inferior access to good quality support.
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Photo © Jayasree Kalathil
development initiative which aimed to find out what person-centred support (its preferred term for personalisation) meant to key stakeholders directly affected by it, what barriers they saw in its way and how these could be overcome. Many different service users, including those in hospitals and under section, and kinds of services were involved in this project and many different lessons could be learned from them. Interestingly, there was an enormous amount of agreement about the issues we focused on among different groups of service users, face-to-face practitioners and carers.
Fundamental changes needed The biggest barriers to person-centred support which people reported – inadequate funding and an inappropriate service culture – are writ especially large in mental health services. The current political stress on public deficit means that funding problems are likely to get worse before they get better. But what this study evidences even further is that unless fundamental system changes take place in the culture of mental health services, moving them on from an essentially nineteenth century medical model approach to a social model fit for the twenty first century, there is likely to be little substantial progress for a person-centred approach in this neglected sector of health and social care. Already the ‘recovery’ model has been subverted into an extension of medicalised thinking and there is little evidence so far that the introduction of personal budgets is escaping the iron grip of diagnosisbased thinking. Yet, ultimately, that is the direction we will have to go in if we are to be true to service users’ understandings of personalisation; that it must really mean a value-based approach that puts the person at the centre rather than fitting them into services, treats them as individuals, listens to and acts on what they say, gives priority to an equal relationship between service
user and worker, and is based on a positive approach “which highlights what mental health service users/survivors are able to do, not what they cannot do.”
Focus on service user voices While personal budgets may currently offer some service users a means of buying support and services outside of the mental health system, thereby escaping its stigmatizing and isolating effects, this does not represent a meaningful solution. That is only likely to come through the fundamental reform of the psychiatric system based on the criteria for person-centred support identified by the key stakeholders who were able to develop their views in the Standards We Expect project. What is now needed is an urgent move to listen to them and act on what they say. We have already had too many ‘expert’ accounts of personalization. It is now time for the voices of service users/survivors to be given priority.
Resources • Standards we expect project: http://www.jrf.org.uk/sites/files/jrf/ social-care-personal-support-summary.pdf • Beresford, P et al (2011) Supporting people: towards a person-centred approach. Policy Press
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