Understanding Direct Payments: 'Is it for me?' A learning journey to direct payments

Funded by the Department of Health (Section 64) and the Learning and Skills Council in four regions (North East, London, South West and East of England), 'Is it for me?' offers a 'no strings attached ' learning opportunity that  empowers people to make informed decisions about personalisation. It enables people to explore whether Direct Payments is an option they want to take up and to identify and address any skills needs required to do so. 

'Is it for me?' offers a bottom-up approach to support implementation of the personalisation agenda and social inclusion and recovery for people with mental health conditions. It aims to improve access to Direct Payments for adults who have mental health difficulties and are eligible to receive them, including carers by  giving people who have mental health conditions and/or their carers the time and space to learn and think about personalisation and self-directed care. 

This project has developed and disseminated materials and lessons learned through the experiences of our pilot projects to support the local delivery of a 2-hour introductory 'is it for me?' learning workshop about personalisation and direct payments and a 10-hour accredited short course, called 'I'll give it a go'

The course has been mapped against the following National Open College Network (NOCN) Step-Up Units:

At Entry 3 level = NOCN Step-UP Qualifications at Entry 3. (National Accredited number 500/3917/9) The award = 3 credits.

At level 1 = NOCN Level One Step- UP Award (National Accredited number 500/3918/0). The award = 6 credits. Learners completing the course at this level face to face would gain 3 credits (and would need to complete another course for at least 3 credits). However, learners who complete the 'I'll give it a go' course as online or as blended learning also gain 6 credits for the ICT element/skills (taking them over the minimum credits required for the award).

Course facilitators ideally include a literacy, language and numeracy tutor working in partnership with a mental health practitioner, mental health service user-trainer or local personalisation team member.  Course delivery costs can be sustained where learning providers' are able to draw down funding for functional literacy and numeracy skills from the LSC and/or by learners using their individual Skills Accounts or perhaps a one-off direct payment.

For many people this opportunity is be an introduction and first step back into learning and the structure of the programme reflects this. The content and the teaching and learning strategies are designed to:

• enable individuals who have mental health difficulties and/or their carers to learn about self-directed support/personalisation
• promote participants' mental health and wellbeing
• develop the confidence and personal skills to decide if and how they want to 'give it a go'
• assist individuals to make decisions about and plan and direct their support
• help people to develop the confidence to apply for direct payments and the skills to manage them (personally or through others)

This project could not have happened without the enthusiasm and involvement of numerous people who have mental health difficulties and our pilot projects, as well as the advice and support provided throughout by the national lead for mental health and personalisation, Robin Murray-Neill.

This work will be of interest to:

• Individuals who have mental health difficulties and/or their carers who want to know more about personalisation and feel able to make choices and decisions to direct their care.
• Mental health and social care service commissioners, local authority and mental health trust's personalisation teams; statutory and third sector social care providers who offer support services to people who have mental health difficulties and/or their carers
• Employment and vocational service workers in (or contracted to) mental health trusts seeking to support people who are eligible for social care to gain or retain employment and learning and skills
• Information, advice and guidance and other further education providers seeking to widen people with mental health difficulties participation in entry level learning
• Local authority training departments and other learning providers who deliver initial and continuous professional development training to staff working in social care

In 2007/08 working with mental health service users; health, social care, housing, employment and learning and skills providers and with the support of the national mental health and personalisation lead, NIACE co-produced a delivery model and curriculum for the 'I'll give it a go' course. This was then road-tested and refined in collaboration with 9 different pilot projects from three regions; the East of England, London and the South West.

Work during 2008/09 included an intensively supported pilot project in Exeter. This involved a partnership between a local authority, mental health trust and a mental health charity, which was also a recognised LSC learning provider. The course was led by a trainer/mental health service user who has personal experience of using direct payments and with coaching support and mentoring provided by the two NIACE specialist consultants in literacy, language and numeracy teaching and learning who were involved in developing the course curriculum in 2007/08. 

Most of our work in 2008/09 focused on getting the workshop and short course 'accredited', national dissemination of the approach, findings from the pilot projects and the materials to deliver the workshop and the production of two hard copy publications:

Is it for me? An information and resource pack for people in a position to make direct payments more accessible for people who have mental health difficulties. This booklet describes the rationale and model that 'Is it for me?' uses and includes examples of the materials used in the 'I'll give it a go' course and directions for how to access the full course materials via NIACE Moodle.

Is it for me? A learning journey to direct payments as part of self-directed support This concertina leaflet, co-produced with people who have mental health difficulties who are using direct payments and personal budgets explains what direct payments are and illustrates some of the different ways that people are using them to arrange and buy their social care. Local authorities, mental health trusts and other agencies are able to customise the latter resource with local contact details. This leaflet has been very popular and despite the national mental health and personalisation lead commissioning additional copies, is unfortunately now out of print and no longer available in hard copy format. 

In addition to disseminating the project resources via the national mental health and personalisation lead, we hosted two stakeholder events and presented information about this project at a number of regional and national conferences.  Following a request from the personalisation team for Hertfordshire, we also developed an online version of the course (enabling individuals to complete the course through self-directed study).

In 2009/10 we developed a free online train the trainers course (via NIACE Moodle) to support people who express an interest in delivering the course in their local area.  This course has enabled a number of people who are themselves mental health service users in the East of England and the North East regions to deliver 'Is it for me?  Workshops and support others to complete the 'I'll give it a go' course.  Support for this 'train the trainers' facility is available until the end of March 2010.  We held a national celebration event, in Cambridge, to make the end of this project on 5th November 2009.

All resources, including full copies of the materials needed to deliver the workshop and course are available (free to download) online via the NIACE Moodle. Resources will be updated and maintained (e.g. through the feedback, experiences, stories and contributions of course participants and with policy developments) up to March 2010. Beyond this date, they will become static resources, which people will need to update for themselves

Documents
	Instructions on how to access the NIACE Moodle

This project provides an example of a proactive and empowering bottom-up approach to people acquiring health literacy skills to support their independence and their engagement with the service transformation required to deliver the personalisation agenda.

'Is it for me?' can be used to complement and support other public education and change management /support strategies for personalisation. This is particularly important if personalisation is to contribute effectively to individuals' recovery from mental health difficulties and their meaningful participation in their communities.

A top down-approach to delivering the personalisation agenda through systems and staff is only ever going to offer a partial solution and risks excluding those who may not have strong health literacy and self-advocacy skills, for example people from Black and Minority Ethnic communities. Much of the early research into the low uptake of direct payments by people with mental health difficulties (compared with other eligible social groups) revealed that both statutory and voluntary sector workers acted as powerful barriers to uptake and at worst created fear among service users. As a result many people with mental health difficulties saw the introduction of direct payments as 'a trick of the State' to withdraw support and close down highly valued services. 

Taking a community development education-based approach offers the potential to engage and empower individuals as citizens - able to make their own decisions and to develop the skills to articulate their wishes and challenge the decisions of others. Rather than creating disaffection or conflict equipping people with health literacy skills  offers them the knowledge and skills to work alongside or in partnership with those agencies that support them, and ultimately to making a difference by contributing to co-producing solutions. 

The ethos and delivery model used for 'Is it for me?' would lend itself well to further support the personalisation agenda by being adapted to other groups of people who are eligible to self direct their care and use a personal budget/direct payments, for example older adults . It would also lend itself to consideration as a way of working to inform the Department of Health personal health budget trailblazer projects and the  forthcoming 'Right to Control' for people who have disabilities, which is being led by the  Office for Disability Issues and the Department for Work and Pensions. Similarly as Skills Accounts roll out nationally this model might provide an effective way to include funding for learning and skills within the qualifying public funding streams covered by Right to Control and enabling people to make effective use of a skills account.