[Peer - Rethink]

Direct Payments webchat, 24th October at 1pm

We are hosting a webchat with personalisation expert Robin Murray-Neill about direct payments and how they can work for people living with mental illness. Robin will be on hand to answer questions about how personalisation so come and take part!.

Direct Payments offer choice and control over how social care needs are met. Rethink Mental Illness have released a report which highlights the benefits of direct payments for people with mental health problems but also the barriers that are still in place which prevent people from accessing a personalised care package. We'd like to bring together people living with mental illness, their carers friends and relatives, local authority and voluntary sector staff to discuss the findings of the report and their experiences of direct payments.

Read a copy of our report on direct payments

Robin Murray-Neill and members of the Rethink Advice & Information Service and research team will be on hand to answer any questions. Robin has worked in health and social care for many years and is a strong advocate of social inclusion, recovery and independent living through the personalisation of support services available to people with mental health problems.

If you have a question, feel free add it below (please note we already have many to answer so apologies if you do not get a response this time).

[Boru]

Hi Robin,

I know quite a few people who've really struggled to access Direct Payments, and didn't get adequate information and advice from their care co-ordinator. In fact, the care co-ordinators didn't seem to know much at all about who who could access DPs, and what they could be used for!

My question is: what would be your advice to people who want to access DPs, but aren't getting the right help from their care co-ordinators to do so?

Thanks.

[mld]

Who is eligable for direct payments? As I don't think that I am.

M.

[Peer - Rethink]

Hello everyone and thank you for joining us for this special Direct Payments web chat, I am joined today by Robin Murray-Neill and Sarah Murphy from our advice team. If you would like to know more about Direct Payments then please visit http://www.rethink.org/dpwebchat where you can find a copy of the report.

If you would like to ask Robin a question about Direct Payments or personalisation then please leave your question in this forum.


Remember that you will need to refresh this page to see new content by pressing the F5 key on your keyboard or using the refresh button on your browser.

[Robin Murray-Neill]

Hello Everyone,

I am really pleased to be here and to hopefully provide some answers that can help, however direct payments and their use in mental health is something I have been working on for around 10 years (and it is still often being made far too complicated for people) so it may be difficult to give full answers in this forum.

I would be happy for you to send any queries via the online form on Rethink Mental Illness website http://www.rethink.org/dpwebchat and the team at Rethink Mental Illness will pass them on to me and I will follow them up with you. But I hope to answer as many questions today as possible.

Let's get started!

[Robin Murray-Neill]

We received a question from 'Dawn' via the web form:

"Can direct payments be used to buy a phone for someone isolated and at risk, through poor support from the CMHT. They said in the past that he could have a pedicure! They have no working knowledge of the system, obviously!"


In principle there is no reason why direct payments can not be used to buy a phone for someone with an identified need for which they would otherwise receive support and which having a phone would meet. Practically, it would need to be agreed who would pay the line rental and call charges.

If however, the person is needing the phone to make up for a lack of support from the CMHT (who would be responsible for putting forward the application for a direct payment) then it is unclear what service the direct payment would be replacing.


If the CMHT are not recognising the person is isolated and at risk (which I can only assume as they are described as giving 'poor support'), then there is presumably not a service currently being offered which direct payments could be used as an alternative to all or part of.

[Sarah - Rethink]

You may also want to contact the Rethink Advice & Information Service to discuss your situation as a whole and see if there is any practical advice the team can offer.

They can be contacted by e-mail: advice@rethink.org or by calling 0300 5000 927 Monday to Friday between 10am and 1pm.

[mld]

Do you have to be on income support to get direct payments?

M.

[Robin Murray-Neill]

Boru posted:

"Hi Robin,

I know quite a few people who've really struggled to access Direct Payments, and didn't get adequate information and advice from their care co-ordinator. In fact, the care co-ordinators didn't seem to know much at all about who who could access DPs, and what they could be used for!

My question is: what would be your advice to people who want to access DPs, but aren't getting the right help from their care co-ordinators to do so?

Thanks.

Boru"


Thanks for your question, unfortunatley there is not a simple answer as care co-ordinators are the gateway to direct payments, since they generally make an application with the individual, however there are a number of ways in which people can get support to progress their enquiries.

1) contact the local direct payments support service who often talk through the process of applying for a direct payment and sometimes will act as an advocate on the person's behalf to enable them to apply (local direct payments support services can be identified through National Centre for Independent Living (NCIL) via http://www.ncil.org....http://www.ncil.org.uk/categoryid21.html )

2) local mental health advocacy services may be able to help

3) ask the care co-ordinator if there is a direct payments worker or champion either in their team or the Trust, they could well be able to advise the care co-ordinator on the correct procedures

4) if there is a local group for people using mental health services they may well have had similar experiences and have some ideas of how to overcome the barriers

5) contact the local council direct payments or self-directed support officer explaining the situation and ask if they can address it from their end.

[Robin Murray-Neill]

mld posted: Who is eligable for direct payments? As I don't think that I am.

M.

Unfortunatley this is not a simple one either, as it varies between local council areas depending on the arrangements they have regarding providing social care support within mental health services. Direct payments are available as an alternative to social care services arranged by the council. For mental health this generally means social care support as arranged by the care co-ordinator. Where is works best when health and social care support is properly integrated, 'social care needs' are identified as part of the CPA process, however in some council areas people are having to fill out a separate assessment of social care needs before finding out if their needs are considered to be eligible.

So, it ranges from 'being on the CPA' and having need for social support through to being separately assessed by the council for social care needs. The mental health Trust should have a booklet explaining clearly who is eligble for the local council area in which you live. If not, the council must provide you with that information.

It is not necessary to have a personal budget in order to get a direct payment.

[Peer - Rethink]

Rethink Mental Illness has a factsheet on Direct Payments that you can download for free from our Mental Health Shop :

http://www.rethink.o...http://www.rethink.org/mental_health_shop/products/rethink_publications/direct_payments_fact.html

or you can browse a full list of free downloadable fact sheets from Rethink Mental Illness by visiting:

http://www.rethink.o...http://www.rethink.org/mental_health_shop/factsheets_az.html

[Robin Murray-Neill]

mld also posted: Do you have to be on income support to get direct payments?

M.

No, it is not a requirement of being eligible for direct payments that you have to be receiving any particular kind of welfare benefit, such as income support.

direct payments are paid to people who are eligible in place of social care services that they would have otherwise received to meet their mental health needs.

[Robin Murray-Neill]

We also had a question from 'John' via the web form. He asked:

"We are a small arts and mental health charity and we are finding that the process to being awarded Direct Payments is causing distress and ill health for those applying. There is seeming inequality and unclear application of criteria. At all levels from Psychiatrists to key workers to the service users themselves and organisations offering services such as ours there is confusion and concerns as to the seemingly impenetrable process for applying for DP."


This is really a statement (rather than a question) of the difficult situation that individuals, local mental health staff and local organisations find themselves in where, as they describe, there is a poor implementation of direct payments. The direct payments guidance has always been clear that the process of obtaining direct payments should be no more difficult than the process for obtaining a commissioned service: sadly it is patently obvious from this and many other examples that it is frequently a process characterised by lengthy delays, lack of information and inappropriate blocking of requests. In places where direct payments are integrated into the ordinary processes of CHMTs and other teams (such as Early Intervention Teams) they have been shown to work well, so staff preparedness and organisational relationships are key factors. As recommended in a previous web chat, MIND have produced a 'Guide for Care Co-ordinators' (as well as a guide for people using mental health services), and much of the 2006 'Direct payments for people with mental health problems: A guide for action' produced by the Department of Health remains relevant (although it was written before Personal Budgets were introduced).

[Peer - Rethink]

If anyone else has any questions about Direct Payments then you are free to add them by clicking the reply button.

Some of the answers are very long so please keep refreshing this page... Sarah and Robin are typing as fast as they can!

[Robin Murray-Neill]

Dawn sent through a good question in relation to carers via the online form:

"I have been a carer for 10 years and have only recently found out about this direct payment.
I have been refused carers credit and am not really sure why. Would this payment be accesible and if so how? Im told I can get help but can't find it.
Thank You"

A direct payment for carers is generally entirely separate from the support services for the person they support. Carers should be informed as part of the process of supporting the person using mental health services of their right to request a carer's assessment, every carer has this right. The care co-ordinator, local carer's group or carer's centre should have information on applying for carers support services, if not the local council should be contacted and people should ask to be put through to carer's services. You will be asked to complete a carer's assessment, following which you should be informed if you are eligible to receive support and if so what level of support. You should be asked how you would like to receive that support, told the range of options available as provided services and offered a direct payment in place of some or all of those provided services.

Some councils have been very proactive offering carers direct payments as their standard method of enabling carers to gain support in their caring role.

[Sarah - Rethink]

Dawn: you may also want to read our factsheet on Carer's Assessments:

http://www.rethink.o...http://www.rethink.org/mental_health_shop/products/rethink_publications/carers_assessment_f.html

[Peer - Rethink]

There is quite a buzz on Twitter this afternoon, here are just some of the comments that have come in so far:

"My view? Income will drop with DLA cuts, & healthcare will increase with Direct Payments. You'll get care, you'll lose petty cash.With the loss of petty cash everything will have to be hugely pre-planned. You'd lose freedom, spontaneity & independent choice."

"Coz it's just too complicated to think about. Sometimes I can't even remember my own name let alone try to sort direct payments..because of the process you have to go through to get them I would imagine #pullingteeth"

"made lots of enqiries re direct payments but CHMT have little understanding of how they work..seems too complex"

"In our area, the CMHT staff do not understand direct payments, therefore patients at risk miss out. "

"It will be 22 months from start to finish before I get my first payment in #Croydon. As the service is that ramshackle."

"Reasons: 1. Bureaucracy. 2. DPs can = rationing (for every happy DP recipient are 10 who get zilch).3.Burden of responsibility."

"direct payments have really improved my life. i'm gaining confidence, self esteem, and my depression has really improved."


Robin is looking at these now and will answer a few of them in just a moment. Remember you can follow us on Twitter via http://www.twitter.com/rethink_ and don't forget that we are on Facebook too via http://www.facebook.com/rethinkcharity

[Robin Murray-Neill]

"It will be 22 months from start to finish before I get my first payment in #Croydon. As the service is that ramshackle." - via twitter.

I'm really sorry to hear about your experience, sadly it is all to familiar. There have been a number of attempts to address the issue of the time it takes to action a direct payment, for example the 2006 Department of Health publication 'Direct Payments to people with mental health problems: a guide to action' but it appears it has not been the will in certain quarters (i.e. some mental health trusts and local councils) to give people using their mental health services the same opportunities for flexibility and creativity in meeting needs as people using other types of service are more able to take for granted.

[Robin Murray-Neill]

Brendah sent another welfare benefits related question via the online form:

"Does the payment come from my benefits or not?

Will I have to pay it back at any time?"


No, direct payments do not come from benefits; they come from social care funds held by councils independently of any benefits. They do not have to be repaid, unless used for purposes other than those agreed, or unspent. They are money paid to the person in place of a service they would have otherwise received. However, people may have to 'contribute' to the amount of their direct payment from benefits they receive in certain circumstances, but this is not to do with choosing a direct payment, but to do with their financial circumstances as assessed by the council and which 'contribution' should apply in exactly the same way if the person uses a provided service and not a direct payment. If a person would have been assessed for charging for a service, then they will be assessed for charging with regard to the direct payment that is made in place of it. This means that they may, subject to the local council's rules, be asked to contribute towards the direct payment from their own resources. Most councils did not used to charge people to use their mental health services (for example Day or Support Worker services), and some have introduced charging on their direct payments whilst still not charging for the service a person would otherwise have received: this is against all relevant guidance on charging, which states that charging policy must be the same however a person chooses to have their needs met.

[Robin Murray-Neill]

This was an interesting question that came from John:

"Why are people on a high (forensic) section not eligible for Direct Payments?"

Since the revision of the Direct Payments Regulations in November 2009, there are no sections of the 1983 Mental Health Act which are now excluded by the direct payments legislation, but people who are subject to drugs and alcohol-related provisions of some criminal justice legislation remain excluded from receiving direct payments. In certain specific instances councils have a power (i.e. they can offer a direct payment if they choose to) rather than a duty to offer direct payments, but in most cases they have a duty to offer direct payments as an alternative to a provided/commissioned service. The Summary document about the changes produced by the Department of Health explains this: "Councils now have the same duty to offer direct payments to eligible people who are subject to mental health legislation as they do to anyone else in all but the following cases: • People who are on conditional discharge from hospital under the Mental Health Act 1983 or the Mental Health (Care and Treatment) (Scotland) Act 2003, where councils will now have a power (but not a duty) to offer direct payments. • In respect of a service which a person is obliged to accept as a condition of relevant legislation*, councils are not required to offer direct payments for that particular service – but have a power to do so. This includes conditions attached to guardianship, leave of absence from hospital or a community treatment order under the Mental Health Act 1983 and certain provisions in criminal justice legislation. (This means that councils now have a duty to offer direct payments to such a person in respect of a service which is not the subject of a condition if the person is eligible.)"