4.6 Is personalisation really for everyone ?
You have been exploring personalisation, and one of its vehicles — self-directed support — in relation to children or adults (or maybe both). You may remember Neill's quote near the start of this section:
The experience of many people who have to rely on human services for their support is that ‘risk’ is the reason given to them by services why they cannot do the things that other people are doing every day.(Neill et al., 2008)
Is risk of harm a reason not to offer people the opportunity to direct their own support? Previous research has identified major inequalities in access to direct payments, especially for people with learning disabilities, those with mental health problems and older people (Ridley et al., 2011, p.73). One of the reasons of this is that practitioners and organisations may make decisions based on 'generalised views about the capacity or ꞌriskinessꞌ of certain groups', especially people with mental health problems (Carr, 2010, p. vi). Self-directed support has taken off even more slowly for children and young people — and there are all sorts of questions about which children in which families should and could benefit from this type of support. As you will see in the next activity, this issue was also explored by our panel in Dumfries.
Activity 4.9 Personalisation for all?
Watch this video of the panel discussing just who might benefit from personalisation, including self-directed support. Make notes in your learning log to answer these questions:
- Do panel members think that personalisation is unsuitable for some people? What are your views about their opinions?
- What tensions about personalisation are identified in this video? Make notes on ways in which these tensions might be addressed.
All the panel members make it very clear that they think that personalisation through co-production is central to the way that professionals and organisations should be working with service users and carers. As John Alexander says about self-directed support in crisis situations, personalisation is not just for 'easier days'. They debate a number of other tensions and challenges, for example:
- personalisation and children and families — and ensuring that the young person's voice, as well as that of the parents, is heard
- Personalisation when compulsion (detention under mental health law, offenders on community payback orders, young people on compulsory supervision orders) is involved.
There are other uncertainties that the panel did not discuss, but which you may have thought about. For example, the role of self-directed support for children in need (children who offend and/or who are at risk of neglect or abuse). As we emphasise throughout this section, whether we are talking about children or adults, balancing the risk of harm with control and choice is a complex matter. At the same time, we need to remember that personalisation is much broader than self-directed support , and there are successes to celebrate. Willie Roe's example of the school in Dumfries and Galloway that has developed its very successful curriculum through their personalised approach to the contributions of children as young as five is a reminder that what is being talked about is a 'whole system' change.
You may have thought about other tensions and questions. Kirstein Rummery makes the important point that it is early days for self-directed support in Scotland. Her research in Scotland and elsewhere suggests that we will make the greatest progress in health and social care by starting small and building on emerging successes as individuals and families gain greater flexibility in their care and support choices.
Find out more
Mental health and self-directed support (In Control,undated)
Leading for outcomes parental substance misuse (IRISS, 2011)