The Emergence of Mental Health Self-Direction: An International Learning Exchange

Croft, Bevin; Wang, Kaipeng; Cichocki, Benjamin; Weaver, Anne; Mahoney, Kevin J.

doi:10.1176/appi.ps.201600014

Cited by 12 publications

(4 citation statements)

References 10 publications

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“…Lived experience work translates to practice that is empowering for consumers and honours individual choice and potential (Mead & MacNeil 2006, Croft et al . 2017). This emergent and increasingly formalized workforce is differentiated from more informal, unpaid peer support that occurs organically and mutually as people in similar experiences provide support to one another within the community (Naslund et al .…”

Section: Introductionmentioning

confidence: 99%

Skin in the game: The professionalization of lived experience roles in mental health

Roennfeldt

Byrne

2021

Int J Mental Health Nurs

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The lived experience workforce has moved from being a grassroots support and activist movement to become the fastest growing workforce within mental health. As lived experience work becomes assimilated within mainstream mental health service delivery, it faces mounting pressure to become more professionalized. Professionalization has evoked both optimism and fear, with diverging views within the lived experience workforce. In this paper, an assessment of the existing professionalization of the lived experience workforce is undertaken by drawing on theoretical positions and indices of what constitutes a profession. The arguments for and against professionalization are explored to identify the risks, benefits, and considerations for the lived experience workforce. The drive for professionalization has largely occurred due to the clinically focused mental health systems’ valuing of professional identity. The argument in favour of professionalization is motivated by a need for credibility within the views of that system, as well as greater regulation of the workforce. However, tensions are acknowledged with concerns that professionalization to appeal to the clinically focused system may lead to erosion of the values and uniqueness of lived experience work and nullify its effectiveness as an alternative and complementary role. Given mental health nurses are increasingly colleagues and often line managers of lived experience workers, it is important at this stage of lived experience workforce development that mental health nurses understand and are able to advocate for lived experience roles as a distinct professional discipline to help avoid the risks of co‐option to more dominant clinical practice.

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Section: Introductionmentioning

confidence: 99%

Skin in the game: The professionalization of lived experience roles in mental health

Roennfeldt

Byrne

2021

Int J Mental Health Nurs

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“…Self-directed care (SDC), which has emerged as a promising model for organizing and financing mental health services, is congruent with recovery-oriented and person-centered care (1)(2)(3). Under this model, people with mental health conditions have the opportunity to select goods and services to support them in achieving their recovery goals, typically with assistance from a support broker or consultant and the availability of funds for making purchases (4). SDC aims to promote empowerment and self-determination, giving people with mental illness greater choice and control over traditional and nontraditional services and sources of support (5) to help them live full and satisfying lives (6).…”

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confidence: 99%

Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care

Thomas

Zisman‐Ilani

Salzer

2019

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Although quantitative research has begun to establish an evidence base for self-directed care (SDC) in mental health, less is known about how people with serious mental illness experience this care, especially in relation to having choices and making decisions. The purpose of this qualitative study was to examine the extent to which people with serious mental illness experienced a greater degree of choice as a result of their participation in an SDC intervention and how their experience of having choices was related to the fulfillment of three psychological needs (competence, autonomy, and relatedness) identified by self-determination theory.

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“…Mental health self-direction, also known as self-directed care , is an approach to organizing services and supports for individuals with serious mental health conditions (Croft, Wang, Cichocki, Weaver, & Mahoney, 2017). It involves an individual budget controlled by the participant with support from a specially trained recovery coach.…”

mentioning

confidence: 99%

Service costs and mental health self-direction: Findings from consumer recovery investment fund self-directed care.

Croft

Battis

Ostrow

et al. 2019

Psychiatric Rehabilitation Journal

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Objective: Mental health self-direction, also known as self-directed care, involves an individual budget controlled by the participant with support from a specially trained recovery coach. The model under study here, implemented in a Medicaid behavioral health managed care context, allowed individuals to intentionally reduce mental health service use and apply cost savings as "Freedom Funds" to purchase a range of goods and services that are not typically considered mental health services to support recovery. This pre-post study examined mental health service utilization and cost before and after participating in self-direction. Methods: The study involved Medicaid claims data for 45 self-directing participants over a 3-year period. Bivariate statistics were computed to identify meaningful pre-post differences in service utilization and standardized monthly costs. Results: Median standardized monthly mental health clinical outpatient costs were significantly lower after self-direction participation compared to before. Participants spent a mean of $182 per month in Freedom Funds to purchase a range of nonclinical goods and services to work toward recovery goals. Total service costs-including Freedom Funds used during self-direction-did not differ significantly before and after program participation. Conclusions and Implications for Practice: Findings from this modest pre-post examination of self-direction suggest that mental health self-direction can result in more person-driven, individualized services without increasing costs. More research is needed to examine the cost-effectiveness of self-direction and to understand how program design and implementation factors influence the relationship between self-direction and service costs. Impact and ImplicationsSelf-direction supports individuals to set and reach recovery goals by accessing a range of goods and services using an individualized budget. This study adds to the modest literature examining cost implications of mental health self-direction and demonstrates that self-direction was implemented in a cost-neutral fashion in a Medicaid managed care context. Future studies should further explore whether and how mental health self-direction can support recovery without substantially increasing service costs.

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The Emergence of Mental Health Self-Direction: An International Learning Exchange

Cited by 12 publications

References 10 publications

Skin in the game: The professionalization of lived experience roles in mental health

Skin in the game: The professionalization of lived experience roles in mental health

Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care

Service costs and mental health self-direction: Findings from consumer recovery investment fund self-directed care.

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