Direct What? The Untapped Potential of Direct Payments to Mental Health Service Users

This article describes research carried out for the Central Research Unit of the Scottish Executive about Direct Payments to mental health service users including people with dementia. Previous research had found that Direct Payments were not often, if at all, offered to mental health service users. Using focus groups, interviews and a telephone survey, Scottish Health Feedback explored the extent of implementation of Direct Payments across Scotland, and the views of mental health service users, carers and professionals about the idea of Direct Payments, the potential obstacles, and the support that would be needed. Awareness of Direct Payments was low, even among professionals. Many were hearing about this option for the first time through this research and a common reaction to the research questions was 'Direct what?' The study found that in order to make Direct Payments work for mental health service users, what was needed was 'person-centred' assessment, access to proper support, advice and training, and Direct Payment schemes that were flexible to allow for different arrangements and for transitions.     

Keeping the cash under control: what's the problem with direct payments in Scotland?

Implementation of the 1996 Community Care (Direct Payments) Act from April 1997 has gradually gained momentum as more and more local authorities have begun to embrace the idea, and develop their own direct payment policies and support structures. However, whilst users have overwhelmingly welcomed this transition, there remains a stark divide between the implementation and promotion of policy in different parts of the UK. This has resulted in only marginal use of direct payments for a small number of disabled persons in Scotland. As legislation moves to widen access to direct payments in Scotland, this article draws on a series of interviews with policy makers in two local authorities and examines some of the key problems that, to date, have prevented many authorities from offering direct payments as a mainstream service option for disabled people.     

'I have got my life back': users' experience of direct payments

After years of activism by disabled people's organizations, the Community Care (Direct Payments) Act 1996 made Direct Payment (DP) schemes a reality. Proponents of DP argue that it allows greater freedom and control for those people using it, but as these programmes only came into effect in 1997, few studies have tried to substantiate these claims. This paper reports on a two-year evaluation of two DP schemes in Wales. Using primarily users' feedback the paper focuses on the effects of DP and difficulties encountered, as well as why people chose—or did not choose—DP in the first place. User responses indicate a broad range of beneficial outcomes, including improved self-esteem, increased control over lives, deeper and more lasting relationships, and new interpersonal, vocational and lifestyle opportunities, as a result of the greater flexibility and freedom of choice enabled by DP. Family carers expressed similar satisfaction with DP schemes, also citing greater freedoms as a result of increased flexibility. While some potential users expressed concern over the administration of a DP scheme, users found that, with support from a user driven Independent Living Scheme, the administrative burden was manageable, and that ultimately the DP scheme was a welcome approach to support.     

'We're not asking for anything special': direct payments and the carers of disabled children

1997 saw the introduction of the Community Care (Direct Payments) Act in the UK. This piece of legislation introduced a mechanism that enabled local authorities to make cash payments to disabled people aged between 18 and 64 in lieu of directly provided services. The years since 1997 have seen the introduction of additional legislation resulting in direct payments now being an option for many more groups of people, including the carers of disabled children. Following the changes in the legislation, government now wishes to see local authorities significantly increasing the numbers of families that receive direct payments. This paper will report on a research project carried out within one local authority in the north-west of England that has one of the largest numbers of carers of disabled children receiving direct payments in the UK. Using a variety of methods this paper explores how the local authority has made direct payments so widely available to carers and the effect that this has had on their own and their children's lives.     

‘It was clear from the start that [SDS] was about a cost cutting agenda.’ Exploring disabled people’s early experiences of the introduction of Self-Directed Support in Scotland

Abstract

The adoption of personalisation represents a global paradigm shift in the organisation of social care. However, such approaches have been criticised for failing to bring about transformative change. The passage of the Self-Directed Support (Scotland) Act (2013) was intended to bring about a significant change in the organisation of social care in Scotland, giving increased choice and control to new user groups. The implementation of the policy at a time of significant financial constraint for local government has cast doubt on this potential. This paper presents findings reflecting disabled peoples’ lived experience of this change during the early stages of implementation. Drawing on one-to-one qualitative interviews with disabled people living across the central belt of Scotland, this early snapshot suggests that the policy had not significantly increased choice and control for service users, and that austerity was leading to an erosion of gains made by existing Direct Payments users.     

The crisis of local authority funding and its implications for independent living for disabled people in the United Kingdom

The recent financial collapse of Northamptonshire County Council sets a worrying precedent for local authorities in the United Kingdom, and in particular for disabled people who depend on services provided by local authorities, such as Direct Payments for personal assistance, for their daily living needs. While the Northamptonshire situation has been blamed on financial incompetence, we argue that it has deeper roots in austerity policies implemented by Conservative-led governments since 2010 on a national level. We also argue that the placement of responsibility for funding personal assistance services in the hands of local authorities creates a deeply unjust ‘postcode lottery’ for disabled people, and we call for a national right to all services necessary for independent living, regardless of cost.     

‘Stuck In The Middle With You’: Towards Enabling Social Work with Disabled People

This article explores progress to date in embedding enabling social work understandings and practices with disabled people by reviewing the UK social work curriculum. Based on these observations and the ideas from UK disability studies, it will offer possible solutions or at least better pathways to enabling practice with disabled people. As Meekosha has pointed out in a global context, to date social work has been experienced as an ambivalent practice [Meekosha, H. & Dowse, L. (2007) ‘Integrating critical disability studies into social work education and practice: an Australian perspective’, Practice, vol. 19, no. 3, pp. 59–72], often both enabling and disabling; an intervention that can both lock and unlock resources, and challenge and reaffirm traditional notions of the ‘disability problem’ [Finkelstein, V. (1993) ‘Disability: A Social Challenge or an Administrative Responsibility?’, in Disabiling Barriers ‐ Enabling Environments, eds J. Swain, V. Finkelstein, S. French and M. Oliver, Sage Publications in association with the Open University, London]. Social work also has the potential to both challenge, but also be an (inadvertent) apologist for contemporary social support and welfare systems. Indeed it is clear that social work as a profession and social care as a policy area have been the poor relations of healthcare and health professions [King's Fund (2011) Social Care Funding and the NHS: An Impending Crisis?, King's Fund, London]. Viewed anthropologically, social work remains a largely non-disabled workforce ‘ministering’ to disabled clients (BCODP, 1997). This might reinforce the perception of ‘us and them’ in some social work encounters. As Paul Longmore questioned, can we begin to go ‘beyond affliction’ (2003) in our work with disabled people? Can social work help support the collective struggles of disabled people or is their role inevitably to reinforce that of individual(ised) clients?

The development of the personalisation agenda and self-directed support is clearly welcome in this context [DoH (2006) Our Health, Our Care, Our Say: A New Direction for Community Services, Department of Health, London; DoH (2007) Independence, Choice and Risk: A Guide to Best Practice in Supported Decision-Making, Department of Health, London; DoH (2009) Personalisation of Social Care Services, Department of Health, London]. Such developments reflect the changing service user–professional relationship. The temptation to see these developments as the icing on the social support cake needs, however, to be resisted. Arguably, with the increased rationing of social support, the continued role of social workers in assessment and monitoring of support could be seen to require a yet more reflexive and enabling professional education and training in an age of austerity, one where previously supported disabled people are being told that their needs can no longer be met.     

Social work and pre-school education in New South Wales

In Australia, males of 65 years and over and females of 60 years are generally regarded as aged persons. Social service and other pensions are payable to this age group. Service pensions are payable to males at 60 years of age.     

Decoding Valuing People

Government policy frameworks on the support of disabled people can often be difficult to 'read', as they contain contradictory elements that simultaneously support and confront social processes that create inequalities and oppression. Valuing People (VP), the UK government's policy framework for learning disability (intellectual disability), provides such a context for work that enhances learning-disabled people's inclusion in community and society, and to reverse some of the systemic disadvantage they have experienced. However, as an uneasy amalgam of the progressive and the neoliberal, the romantic and the practical, it has been difficult to evaluate in order to use its opportunities and minimise its dangers. This article attempts to decode VP in terms of ideologies in human services, and the current New Labour policy mix. Its emphases on Person Centred Planning, Direct Payments and employment will be analysed to try to establish what VP means, and to suggest more adequate priorities. This analysis might also be relevant to other sectors where there is a similar problem of decoding their particular policy context.     

Service Provision for an Independent Life

How is an independent daily life possible for disabled people when relying upon professional service provision and the bureaucratic gate-keeping systems of the welfare state? This article discusses this question in relation to an interview study. Eighteen mobility disabled and 20 service providers in one local setting in Norway were interviewed. We point out at least three categories regarding how independence is interpreted among the disabled: the super-normal, the independent living activists, and those experiencing powerlessness and lack of support. The analysis points out how these categories are constructed in relations between the disabled person, professional service providers and the gate-keeping systems of the welfare bureaucracy.     

Choice: what,when and why? Exploring the importance of choice to disabled people

Extending choice and control over public services is central to current policies in England. Such policies have immense potential for independence and well‐being. However, it is still not clear how disabled people conceptualise choices, what choices are important, for which groups of people, in what areas of life and why. This paper presents findings from the first phase of a longitudinal qualitative study of choice and control over the life‐course. Semi‐structured interviews were carried out with 111 participants including disabled young people with progressive conditions; their parents; adults and older people with fluctuating support needs and those experiencing sudden deterioration in health. The findings suggest that while most people across all study groups wanted to be able to make choices in all areas of their lives, there are significant differences in the importance they attach to specific choices. The findings have implications for service reforms and identify some policy and practice issues that need to be addressed.     

Increasing Opportunities for Co-production and Personalisation Through Social Work Student Placements in Disabled People's Organisations

Social work student practice placements in disabled people's organisations offer several advantages for individual students, their peers and tutors, and DPOs themselves, who can offer placements for students in supporting service users to give their views as well as delivering social care services. In this context professional skills and anti-discriminatory practice are fostered through learning directly from disabled people as experts without the constraints of local authority policies.

This paper draws on my experiences of such student placements at Wiltshire and Swindon Users' Network over a 15-year period, 1993–2008, in collaboration with different universities. The social work student on placement here experiences an alternative organisational culture which recognises service users' expertise over professionals. The student learns to value collective peer support and working with activists who view their experience through the framework of the social model of disability. This facilitates a two-way exchange as the student learns about user-led practice and the disabled activists appreciate the skills the student brings.

The advent of policies of personalisation, the Big Society and the decreased role of local authorities is challenging the traditional model of adult care social work within local authorities. The placement of social workers in local centres for independent living, in order to provide intensive one-to-one support in support planning for those in complex situations, is only likely to increase in future. This can be seen as a positive alternative which enables professionals to rediscover their professional values and practice and extends the opportunity for placements beyond DPOs concerned with user involvement only.     

Options to liberalize Social Security disabled widow(er)s benefits

Each month, 200,000 widows and 6,000 widowers receive Social Security disabled widow(er)s benefits, each benefit averaging about $550. Among the most economically at-risk Social Security beneficiaries, their benefits are permanently reduced. This paper reviews the legislative history of the disabled widow(er)s benefit, identifying key decisions that gave shape to this benefit. Social Security program data and six years of Current Population Survey data (March Annual Demographic Files, 1995-2000) are used to profile the economic status of current and potential disabled widows. The analysis, including comparison with other widows, provides strong evidence of economic need among disabled widows with, for example, 44% of disabled widow beneficiaries, ages 50-59, having below-poverty incomes compared with 15% of like-aged non-disabled widows. We conclude that serious consideration should be given to extending eligibility to all widow(er)s disabled before the normal retirement age; to providing a benefit equal to 100% of the deceased spouse's private insurance amount (PIA); to eliminating the unnecessarily restrictive seven-year rule; and to protecting beneficiaries from losing their eligibility to Medicaid. Even in the context of today's heated Social Security debate, we suggest that a rare opportunity may exist to garner bipartisan support for meaningful, low-cost improvements, in a benefit that primarily targets women.     

Moving the Boundaries of Feminist Social Work Education with Disabled People in the Neoliberal Era

Until recently social work education in Australia has either marginalised or neglected disability by omission. Given the increasing number of disabled people in the community, the teaching of social work within a disability studies emancipatory paradigm as an essential part of the curriculum is long overdue. As many social work educators have suggested, we are at a critical moment in Australia, where the policy environment in which social work is embedded has largely been reframed in line with neoliberal trends. For disabled people, this has meant an ongoing state campaign to diminish disability entitlements, from decreasing disability social security regimes through to the rationalisation of adult disability support and care schemes. Social workers are negotiating the competing demands of these policy constraints alongside the needs of the disabled people they work with. New moral dilemmas have emerged where they are actively faced with the question of ‘who to serve?’.     

Abuse and Disabled People: Vulnerability or social indifference?

This paper analyses current literature surrounding issues of abuse and disability, and discusses whether the forms of abuse experienced by disabled people results from an individual vulnerability, or as a consequence of social attitudes towards disabled people. Three case studies form supportive evidence, and have been compiled from personal research, they represent a combination of abusive features, rather than any one individuals situation. The study hopes not to suggest that all disabled people are especially vulnerable to abuse, but asks if society and existing welfare services acknowledge and respond to allegations of abuse without prejudice to disability. This study formed my dissertation paper as a student on the BA (Hons) Social Work and Welfare Studies at the University of Central Lancashire, and I would like to thank my dissertation tutor, Bob Sapey, for his guidance and support throughout the study.     

Personal assistance at work: the Visual Assistance Service in Taiwan

'Personal assistance' is a key to equal and full participation by disabled people in society. In Taiwan, there are services provided to 'care for' disabled people, but not to support them at work. In view of this, a pilot scheme called the 'Visual Assistant Service' was developed in 2003. This study explores how the visually impaired users, project workers and Visual Assistants viewed the service. The findings show that this service has improved visually impaired workers' sense of control at work and reduced their enforced dependence on their informal support networks. However, users had little control over the way the services were provided. This reveals a lack of full understanding by professionals with regard to the western ideas of 'personal assistance' and the independent living movement.     

Spiritual Transformations in Clinical Relationships Between Social Workers and Individuals Living with Disabilities

Abstract

Some individuals living with disabilities have expressed a need to have spirituality recognized within clinical relationships. Social workers and other professionals have not responded to this need and therefore, there is a growing difference between what individuals with disabilities need and what clinicians, including social workers, are providing. Jean Vanier is a Canadian who has spiritual wisdom gained from over 40 years of living with people who have disabilities. Applying insights from both Vanier and transformational learning theory, this paper demonstrates that Vanier's approach is an important resource as social workers integrate spirituality into the clinical relationship with disabled individuals.     

Positive You: a self-advocate’s arts-based approach for building self-esteem

Positive You is an inclusive arts project supporting learning disabled people to explore self-esteem through art-making. The project was developed by self-advocate Leah Jones who observed a gap in service provision after struggling with her own confidence and self-esteem for many years. This article has been co-written by Leah and her support Jade French using a life-story approach. Leah hopes that by sharing her story, this article will not only demonstrate the value of art-making in developing self-esteem, but also that learning disabled people can develop their own employment opportunities with the right support.     

The exclusion of older people in disability activism and policies — A case of inadvertent ageism?

Using Sweden as a case, the article discusses the tendency within disability activism and policies to overlook elderly people. From an analysis of a major Swedish government investigation on disability it is clear that disability policies in Sweden have come to rest upon stereotyped age norms that divide the life course into set stages, and there has been a tendency to define elderly disabled people as elderly rather than disabled. It is argued that this exclusion is partly the result of a successful endeavor to provide disabled people of younger ages with rights that are typical of non-disabled citizens. Justice and equality have been defined in comparison to citizens of similar ages: children, youth and adults of “active age”. Based on the analysis of the paper it is argued that activities of movements struggling to liberate oppressed populations may contribute to ageism, and that anti-ageist research must go beyond the idea that ageism is a simple matter of attitudes towards older people.     

Representing the Views of Disabled People in Community Care Planning

The 1990 NHS and Community Care Act requires social services departments in Britain to involve representatives of service users in the preparation of their annual community care plans. This paper gives a critical account of the different ways in which the views of disabled people are sought and represented in community care planning; and of the organisational and practical barriers which disabled people and their organisations are likely to encounter in representing their views to service planners. People with learning disabilities, older disabled people, people with sensory impairments and disabled people from Black and ethnic minority communities are particularly likely to be excluded from current consultation procedures. The paper concludes that present methods of representation place considerable burdens on both individual disabled people and on their organisations. Consequently, disabled people may increasingly question the effectiveness and usefulness of their involvement in community care planning, in the light of the many other issues which are important to them.