Personal budgets allow individuals with mental health issues to tailor their care to meet their personal needs. Research shows personal budgets improve well-being, independence, and management of conditions. However, they are not widely used in mental health. Barriers include challenges with the application process and a lack of clarity around budget rules. While personal budgets have benefits, further research is needed on their effectiveness for different groups.

1. Module code: PS71071A
Module name: Professional Issues in Clinical Psychology
Student ID: 33329518
Word count: 1476

2. ‘Why are personal budgets not used more in mental health?’ – A response
It would appear that the benefits of personalisation of care, specifically
personal budgets, outweigh the costs. Yet, as highlighted by Rob Greig’s (2015)
article for the Guardian, personal budgets are not used particularly frequently in
mental health services. They act as a tool for individuals with disabilities and/or
mental health problems to be able to tailor their care to suit their individual needs. For
these individuals, the independence that comes alongside having money is very
important to aid in the achievement of vocational and social goals (Shepherd,
Boardman, Rinaldi & Roberts., 2014). The evidence seems to indicate a wide range of
positive outcomes for individuals receiving budgets, with any negativity being
attributed to difficulties with the process of gaining the personal budget itself. Why is
it then that personal budgets are not used more frequently?
The psychological benefits of allowing individuals with mental health issues
to tailor their care to suit their personal needs are well documented. The 2011 POET
Survey (Personal Budgets Outcome Evaluation Tool) reported that the majority of
personal budget holders reported improved mental and physical wellbeing, feelings of
independence and control over their own care (Hatton & Waters., 2011). Rob Greig
(The Guardian., 2015) stresses how well suited personal budgets are to the recovery
approach to mental health, a model designed to encourage those with mental health
problems to look beyond their diagnosis and to move forward, to develop social
relationships and set goals. The recovery approach is a key element of current
government policy, with schemes such as ‘Think Local Act Personal’, which aim to
work with the whole individual, their families and friends to work towards better
outcomes. Personal budgets have been used by ‘Think Local Act Personal’ to help
individuals to work towards increased autonomy, particularly increased independence
within the local community. For clinical psychology, and other mental health services,
if personal budgets can reintegrate an individual into the community this could lead to
less pressure on services in the long term. Community support and social networks are
well established to positively impact mental health and wellbeing, potentially through
the stress relieving effect that social relationships can have (Thoits., 2011). I feel as
though the value of patient-centred approaches, such as personal budgets, is supported
with a strong evidence base. Patient-centred care in a variety of physical and mental

3. health settings has been shown to improve adherence to treatment regimens, increase
patient satisfaction and lead to improved outcomes (Stewart, 2001). Compared to
directly provided services, which can be perceived by users as rigid and limited,
personal budgets provide a flexible option for provision of care. As emphasised by
Rob Greig, personalised care options are perfectly suited to the heterogeneous and
changeable nature of some mental health disorders.
‘Empowerment’ is a particular buzzword in the discussion of personal
budgets; it is a term that refers to an individual’s feelings of being able to make a
meaningful impact on their personal life and social network. For individuals with
mental health disorders gaining control over their own lives may have at times felt
impossible. Personal budgets seem to be a successful way of empowering individuals
with mental health problems by providing them with a sense of control, confidence
and independence (Glasby & Littlechild., 2009). Moreover, research indicates that
personal budgets actively impact a wide range of other outcomes, in addition to
improved wellbeing. These can include better management of relapses and decreased
use of accident and emergency services and GPs over a time frame as short as 9
months (Davidson et al., 2012). It is also worth noting that individuals with council
managed personal budgets do not report as many positive outcomes as those in receipt
of direct payments (Hatton & Waters., 2011).
It is important to recognise any potential barriers to recipients of personal
budgets. Research suggests that the effectiveness of personal budgets may actually
vary between groups, in particularly different age sub-groups. Older adults seem to
respond to personal budgets very cautiously and their wellbeing does not improve at
the same rate as younger people using budgets (Newbronner et al., 2011). It seems as
though responsiveness to personal budgets is very variable depending on the
individual and a range of other factors. While I would recommend a wider use of
personal budgets, the appropriateness for particular groups needs to be considered.
Another barrier, as mentioned previously, is that some recipients find the process of
gaining the budget very difficult and many carers/family members express concern
about the worry and stress associated with the process (Hatton & Waters., 2011). In
addition to this, research has indicated that the tangible benefits of personal budgets,
such as those mentioned previously, can actually be reduced by setbacks in the
implementation of the budget itself. For some, a particular issue was the feelings of
uncertainty about the future of their budget past the first 12 months and confusion

4. about what the budget could be spent on. These individuals did not report the same
improvements compared to those who did not find the process particularly
challenging (Davidson et al., 2012). This is a key issue to recognise and resolve. If the
process is negatively impacting on a range of improvements normally associated with
personal budgets, something needs to be changed before the scheme is used more
widely. I would argue that some individuals would benefit from services providing
more clear and accessible information about the details of the ‘rules’ for personal
budget use to prevent unnecessary uncertainty and stress.
The fact that personal budgets may take some strain off emergency
services and local medical practices is important when considering the economic
consequences of personalisation. I would argue based on the research mentioned
above, that it is possible that if personal budgets were rolled out more broadly there
would be scope for possible financial savings as a result of a reduction in demand for
acute services, and maybe even a reduced need for long-term in-patient care. Some
local authorities using personal budgets also showed a reduction in demand for some
over-subscribed services, specifically day-centres (Brookes, Callaghan, Netten, &
Fox., 2013). Sceptics argue that while some of the burden to acute services may be
lifted by personal budgets, the scheme disempowers social workers and care staff
(Duffy., 2012). I would assert that this need not be the case, and that mental health
professionals can and should be actively involved in the development of support plans
for personal budgets in an advisory capacity.
Further criticism is directed at the economic implications of personalisation.
There does seem to be an issue that the majority of personal budget spend is not
contained within the NHS, 80% of spending is outside the public sector compared to
80% of spend feeding back into the NHS in the traditional system (The Guardian.,
2015). Furthermore, recent large-scale reviews into local authorities attitudes towards
personal budgets revealed that they viewed personalisation as a response to budget-
cuts, as opposed to a tool for empowering those with mental health problems
(Brookes et al., 2013). This is a clear example of the attitudinal and organizational
barriers mentioned by Rob Greig (2015). It is understandable why some hold views
such as these and have issues with the spending not being contained within the NHS.
However, I believe that the potential savings in the long term need to be considered
by the individuals responsible for assigning and implementing personal budgets. It
will also be of interest to see how personalisation of mental health care, and personal

5. budgets in particular, fare after the upcoming elections.
Personalisation of mental health care in the UK in the form of personal
budgets has been fiercely debated. Personal budgets have consistently been linked to
an array of beneficial outcomes, from reduced use of emergency services, feelings of
independence (Hatton & Waters., 2011), better management of relapses (Davidson et
al., 2012) and achievement of personal goals (Shepherd et al., 2014). Considering
this, the apparent resistance on the behalf of some services and councils to allocate
budgets is surprising. I would argue that personal budgets have the potential to be
extremely beneficial for some, however further consideration and research is needed
into which individuals would respond best to them. It is important to recognise that
some groups in society, such as the elderly, may respond better to the more traditional
systems (Newbronner et al., 2011). In addition, significant changes need to be made
to the process of applying, reviewing and gaining personal budgets, as the process
itself seems at times to be a barrier to the positive outcomes associated with the
scheme. To reiterate Rob Greig (2015), some authorities do not seem to be engaging
with new developments in care practice, specifically personal budgets, for those with
mental health problems. I personally struggle to see why a well-evidenced care option
with the potential for important psychosocial benefits for those with mental health
problems should be overlooked any longer?
REFERENCES:
Brookes, N., Callaghan, L., Netten, A., & Fox, D. (2013). Personalisation and
innovation in a cold financial climate. British Journal of Social Work.
Davidson, J., Baxter, K., Glendinning, C., Jones, K., Forder, J., Caiels, J., Welch, E.,
Windle, K., Dolan, P., & King, D. (2012). Personal Health Budgets:
Experiences and outcomes for budget holders at nine months. York: Social
Policy Research Unit, University of York.
Duffy, S. (2012) An Apology. The Centre for Welfare Reform, 30Oct, 2012

6. Glasby, J. & Littlechild, R. (2009). Direct payments and personal budgets: putting
personalisation into practice. Policy Press.
Greig, R. (2015) Why are personal budgets not used more in mental health? The
Guardian, 6 Jan, 2015
Hatton, C., & Waters, J. (2011). The national personal budget survey. Lancaster:
Lancaster University.
Newbronner, L., Chamberlain, R., Bosanquet, K., Bartlett, C., Sass, B., &
Glendinning, C. (2011). Keeping Personal Budgets Personal: learning from the
experiences of older people, people with mental health problems and their
carers. Social Scare Institute for Excellence. Adults Services Report, 40.
Shepherd, G., Boardman, J., Rinaldi, M., & Roberts, G. (2014). 8. Supporting
recovery in mental health services: Quality and Outcomes. Implementing
Recovery Through Organisational Change, London.
Stewart, M. (2001). Towards a global definition of patient centred care: the patient
should be the judge of patient centred care. BMJ: British Medical Journal,
322(7284), 444.
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and
mental health. Journal of Health and Social Behavior, 52(2), 145-161.

7. Glasby, J. & Littlechild, R. (2009). Direct payments and personal budgets: putting
personalisation into practice. Policy Press.
Greig, R. (2015) Why are personal budgets not used more in mental health? The
Guardian, 6 Jan, 2015
Hatton, C., & Waters, J. (2011). The national personal budget survey. Lancaster:
Lancaster University.
Newbronner, L., Chamberlain, R., Bosanquet, K., Bartlett, C., Sass, B., &
Glendinning, C. (2011). Keeping Personal Budgets Personal: learning from the
experiences of older people, people with mental health problems and their
carers. Social Scare Institute for Excellence. Adults Services Report, 40.
Shepherd, G., Boardman, J., Rinaldi, M., & Roberts, G. (2014). 8. Supporting
recovery in mental health services: Quality and Outcomes. Implementing
Recovery Through Organisational Change, London.
Stewart, M. (2001). Towards a global definition of patient centred care: the patient
should be the judge of patient centred care. BMJ: British Medical Journal,
322(7284), 444.
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and
mental health. Journal of Health and Social Behavior, 52(2), 145-161.