Personal health budgets are a way of offering individuals with disabilities and long-term conditions greater choice and control in how the NHS supports them in improving their health and managing their care.
The national personal health budget evaluation (2014) found that personal health budgets had particularly positive impacts for those with mental health conditions. The pilot programme included more than 20 areas that offered personal health budgets for mental health and found that the use of PHBs resulted in significant improvement of people’s quality of life and wellbeing and were cost effective. These areas worked with a range of different populations, from older people with dementia to young people in early intervention services, and with a range of types and size of budget.
The NHS Long Term Plan published in January 2019 made a clear commitment to expand personalised care and personal health budgets, with a specific expectation that they will be offered within mental health services as part of plans for up to 200,000 people to benefit by 2023/24.
Following an announcement in February 2019, people who are eligible for section 117 aftercare under the Mental Health Act will have a legal right to a personal health budget from 2 December 2019. Further guidance is available for health and social care professionals on implementing the legal rights to personal health budgets, including section 117 after-care.
After-care services under section 117 of the Mental Health Act covers the provision or arrangement of help and support for people who have been detained in hospital under sections 3, 37, 45A, 47 or 48 of the Mental Health Act 1983, when they leave hospital.
For this group, a personal health budget may be considered whenever planning is taking place for section 117 mental health after-care needs during an admission to hospital, or at any assessment held to review the person’s section 117 after-care package of support in the community.
Personal health budgets and the recovery model
Personal health budgets are closely aligned to one of the central strands of service transformation in mental health: recovery. Adopting a recovery focused approach to mental health services means moving beyond symptom and risk management to support people to re-establish a meaningful life for themselves with their mental health condition. Recovery requires services to look beyond treatment to consider wider issues such as housing, employment and family relationships. As a highly personal journey, recovery depends on services being able to develop individually tailored approaches. Personal health budgets are a tool to support more recovery focused services by allowing individuals to define their own outcomes and design their own packages of care and support.
Personal health budgets for mental health in action
Nicola spent a significant period of time in psychiatric hospital, and has had multiple contacts with police, mental health services and A&E. Numerous services had been offered and tried, but had not helped her mental health. Through coproducing a personalised care plan, Nicole was offered a personal health budget, which aligned her treatment with what was important to her. This included a climbing course, equine therapy, peer support and a woodwork class. Through this package of care, Nicola has since only made appropriate contact with mental health service and has not required emergency services or been admitted to hospital since. Nicola and her family feel the package of care has given Nicola an opportunity to start afresh.
Nicola said, “The first thing is that I actually have a future, so before there was no point in me having a future and I didn’t want it. Now I’m not just looking at things today or tomorrow, I’m actually looking at things months and years ahead”
Mason had been a mental health inpatient for 18 months before receiving his personal health budget. The standard offer from services wasn’t going to meet his needs, so his personalised package of care allowed him more choice over the care he received, and has helped him transition to a more independent life. He’s now successfully lived at home for over a year.
Mason said, “I am alive and here for my boys”
“Mason would not be at home if it wasn’t for his package”- Mason’s wife
Shelley was able to choose her own support team and design her package of care through her personal health budget. At just 24, she’s experienced a number of admissions to Psychiatric Intensive Care Units (PICUs) and exhibited challenging behaviour. By identifying what was important to her, Shelly was able to return home and is now making sustained progress. Shelley is now actively planning for her future, rebuilding relationships and has completed a university course.
Shelley said, “I am now happy and chilled”
Implementing personal health budgets for mental health and need more information?
If you work within the NHS, a local authority or a voluntary sector partner, you can sign up to the Personalised Care Collaborative Network to access a range of resources, share learning and discuss issues with colleagues across the country. To discuss access please email firstname.lastname@example.org
Alternatively, for more information please see the overview of the support available for professionals, or contact the national Personal Health Budgets team by emailing email@example.com.