Laura’s story

After 18 months of unsuccessful psychotherapy, Laura, 23, now has a flexible support package thanks to her personal health budget, which helps her effectively manage her mental health problems.

Laura lives in the south of England and works in healthcare. It was January 2015 when Laura first heard about a personal health budget. She has a diagnosis of borderline personality disorder and for over a year she had been receiving mentalisation based therapy (MBT), which she found “incredibly distressing”.  MBT is a type of psychotherapy where the therapist aims to support the client to have a better understanding of their own intentions and those of others. Whilst she knew it worked for some people, she wanted to find alternatives that were more suited to her, focussing on how she could manage her difficulties in the moment.

Fortuitously, where Laura lived there was a pilot project underway to trial personal health budgets for young people with complex needs, who were in transition from children’s to adult services.  Along with her psychologist and a colleague (the local personal health budgets lead), they began to explore the possibility of a personal health budget as a different way of managing her mental health problems.

Back at university, Laura had worked with a mentor who helped her to establish routine and structure, providing support with things like shopping and tidying, budgeting and liaising with health professionals.  Laura felt that working with a mentor again might help address some of her needs, and together with professionals they agreed a personal health budget support package to include time with a mentor and gym membership.

The budget was set up so that Laura now receives most of her personal health budgets as a direct payment, with a pre-paid card to record exactly how her budget is spent. This means she doesn’t need to send invoices or receipts to the ICS. Her gym membership is paid upfront by the ICS and is managed as a notional budget.

Reflecting on the benefits of her personal health budget so far, Laura feels it gives her a level of flexibility that traditional services wouldn’t. Her mentor, Anna, doesn’t work strict 9am-5pm hours, meaning the support package can be flexible when Laura is finding things more difficult.

Moreover, Laura’s mood has improved significantly, and she believes the personal health budget “has changed the path of my life”.  It is a personalised approach, centering on self-management techniques. “And because I chose this approach myself, rather than being handed a limited choice of traditional therapy, I feel more empowered and dedicated to making it work”.

Laura acknowledges that personal health budgets won’t work for everyone, but believes there is real potential for young people moving over to adult mental health services, or who have a diagnosis of personality disorder.

“From what I understand there is very limited evidence (for personality disorders) about what works, so why not give people more choice about the support they receive?”

In Laura’s view the biggest risk is not implementing personal health budgets properly. She has heard about people with personal budgets in social care who don’t know that they have a budget, and she is reportedly the only person in her area who receives their personal health budget as a direct payment, which really worries her. “We do need to put in place some limits on what support people can access through a personal health budget, but ultimately we have to be able to trust the individual and the clinician to make choices that meet the individual’s health and wellbeing goals”.

Laura would like her story to encourage more ICSs to consider how personal health budgets can support people struggling with mental health problems. Crucially, the issue of transitions between services is not going away, and for Laura, personal health budgets offer a chance to stop people from slipping through the net.

Laura’s top tips:

  1. Make sure that clinicians and staff working in provider services understand what personal health budgets are, how they are offered and who is eligible for one. “Let’s make this a real culture change”.
  2. Do it properly. Consider increasing the number of people who receive direct payments, so that it isn’t just a tick box process, but represents a real shift in control to the individual.
  3. In many areas of mental health, we still don’t really know what works. Evidence based practice is all very well if the evidence is there. If it isn’t, the best person to ask about what might work is probably the person themselves. It might not work, but why not give it a go?