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Direct Payments in mental health: what are they being used
for? 2. updated August 2007-1
Direct payments are made for social care:
“Guidance to staff should be succinct and unambiguous, particularly in
relation to the definition of health care (which involves a clinical/medical
intervention) and social care (which includes “access to day services, support
worker services, respite breaks, non-specialist alternative and physical
therapies, education, leisure and employment opportunities”i). “
Department of Health (2006) Direct payments for people with mental health problems: A
guide to action
Local Authorities vary considerably in the range of activities they
will agree to fund by direct payments. One of the key statements in
this respect comes from the Government guidance, which confirms
the intention of direct payments: to give choice and control to the
individual:
“One of the intentions of direct payments is that people are enabled to
determine for themselves the best way of meeting their needs:
"As a general principle, local councils should aim to leave choice in the hands
of the individual by allowing people to address their own needs as they
consider best, whilst satisfying themselves that the agreed outcomes are
being achieved."ii ”
Department of Health (2006) Direct payments for people with mental health problems: A
guide to action
The most comprehensive account of the uses to which direct
payments have been put in lieu of mental health services is the
HASCAS Evaluation of the 5 Pilot Sitesiii.
HASCAS Report: Key Findings - Uses
Social support
Domestic support
Personal care
Practical support
Transport
Education
Arts
Leisure
Respite
Childcare
Therapeutic support
Night sits
(Spandler and Vick, 2004)
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
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The HASCAS report contains a number of case studies:
“The following sections look at particular examples of support arrangements that
individual clients have developed through direct payments.
NIGHT SITS
One client used direct payments to employ someone to stay with her during the night.
She employed a PA to do two waking night sits per week when she felt she needed it
most (for example at weekends).This client had ongoing serious and escalating selfharm, difficulties sleeping and would often feel particularly unsafe and vulnerable at night.
The PA would either help out with household chores while the client slept, or sit up with
her if she couldn’t sleep.This enabled her to sleep and has helped reduce the severity
and amount of self-harm.
It’s very flexible. She comes in the evening and we have a drink and chat and take the
dog for a walk sometimes and then I’ll go to bed at whatever time and she might do some
cleaning for me or whatever…then she sits up all night and when I get up during the
night, I have got someone to talk to. That just gives me a chance to get some sleep,
because I don’t sleep very well, and I self-harm quite a lot…Just knowing that somebody
is going to come in and spend the night and it gives me a bit of a break, somebody to talk
to and I know I can phone her up too.
CULTURALLY SENSITIVE SUPPORT
A South East Asian family used direct payments to employ a PA to help support a young
man with complex needs. He needed to have another Asian worker from a similar
background and culture to whom he could relate. He was extremely isolated and slept
irregularly. Social services had been unable to provide him with an Asian social worker or
support worker and he could not relate to mental health services. His mother employed
an Asian PA and a cleaner on his behalf. The PA was employed to develop a relationship
with him and to facilitate greater social contact.
Because of the nature of the young man’s support and the necessity of finding a suitable
PA with specific cultural, language and mental health skills, it was agreed to pay a higher
hourly rate than usual. The mother guides the PA and facilitates communication between
the PA and the client and helps him to decide what he would like the PA to do with him
before s/he arrives. She reported that her son is slowly beginning to relate to the new
worker.
We have been asking for over two years for an Asian social worker and social services
haven’t helped us. We just want Asian people who can give a service to him…
We didn’t have anyone coming round no visitors. He doesn’t sleep at night and is awake
during the day… The PA just comes and talks to [him] and tries to go out with him. It
takes so long just starting to say ‘hello’. Before she comes I ask him what he’d like her to
do and then I tell her when she comes… whether it’s to get some shopping in or
whatever… It’s like I’m helping her to help him helping people to communicate with
him.They also need to know that they need to be careful e.g. not to wake him up when
he’s sleeping.
EMPLOYING RELATIVES
Another client employs her mother as a PA for a variety of social, personal, and domestic
support37. In this instance, it was agreed that the client’s mother was the best person to
provide the intensive support this particular client needed and was someone whom the
client trusted and accepted:
I don’t have to tell mother what to do, because she knows what to do, she knows about
my medications, she is always aware of my appointments, and also the care involved
with my daughter. Also, she recognises the nature of this illness so she can see when I
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
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am becoming ill. If my mother says I am going high, she will go and make an
appointment and seek further help for me before it escalates…. She takes me out and
encourages me to do things and be amongst people.
USING DIRECT PAYMENTS COLLECTIVELY
Finally, a group of five clients were using direct payments to attend a creative arts
group.The group employs two trained artists who work with a local mental health
artsbased charitable organisation.The artists work alongside the individuals providing
ideas and motivating them to explore their own creativity, and helping them turn ideas
into reality.
All group members live in a rural area on the border of two counties, an area which is
quite cut-off and not wellserved by services or local transport. It is really important to the
individuals that the group is local and within walking distance. The group was formed in a
local Community Centre and prior to direct payments, the group had to constantly
fundraise to just to keep it going. However, this was causing the group considerable
anxiety and affected morale.They shared a care co-ordinator (a CPN) who had heard
about direct payments and suggested it as an option for the group, who responded
enthusiastically. The CPN knew how important the group was for its members and
pursued it for them. The group recognised that getting direct payments was very much
dependent on their having had a supportive care co-ordinator. Each client gets an
individual payment which they then pay to the creative response artists.
Since getting funding from direct payments, group members reported that their morale
has significantly improved. They still fundraise but this contributes towards exhibitions
and other developments of the group. It would have been impossible for each individual
to get the input of trained artists alone. In getting direct payments, not only has each
individual been able to access support with their creative art, but also the payments have
facilitated the development of an environment where clients can benefit as a group
from each other.”
(Spandler and Vick, 2004)
Other examples are on the pages that follow:
1.
2.
3.
4.
5.
6.
7.
Direct Payments and me (Essex County Council, 2005)
Direct Payments (Lancashire County Council, 2005)
Uses of direct payments (Norfolk County Council, 2005)
Extracts from New Directionsiv (Joseph Rowntree, 2005)
Using direct payment monies flexibly (DH, 2003)
Supporting parents with mental health problems (DH, 2003)
Direct Payments for people with mental health support needs
(Pauline Heslop, 2001)
8.
Case Examples (Essex County Council, 2003)
9.
Mental Health service users and direct payments, Maureen
Harris, Southampton CIL (2005 National Centre for Independent Living)
10.
Comments about Direct Payments (Christian Wakefield,
November 2005)
11.
MIND YOUR HEALTH – with Direct Payments (Richmond
Users’ Independent Living Scheme, Dec 2005)
12.
Stepping On Out – an excellent example of support to gain employment from services
for people with a learning difficulty (Richmond Users’ Independent Living Scheme, May
2006)
13.
Examples of how Direct Payments have been used by Devon Mental Health Service
Users and Carers
14.
‘Direct Payments’, from Viewpoint News Spring 2007: one person’s account of their
interest in and use of direct payments
15
Direct Payments – a great opportunity and a cautionary note. One person’s
experience from Norfolk
16
Direct payments for short breaks (‘respite’) in Hertfordshire
17
Direct payments for carers in Poole
18
Direct payments and Social Enterprise: Stepping Stones, Sutton Colefield
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 4of 31
DIRECT PAYMENTS AND ME
I’d like to introduce myself. I am a service user, I live in the Essex
area and I have had a long history of engagement with statutory
and health services. I must say that some of these experiences
have not been to my liking but more recently things have changed
for the better.
I have often struggled due to my mental health difficulties to
manage my own needs and the needs of my children, and this has
meant that 3 of my children have been adopted and this makes me
very sad. But let me tell you about the good things that have
happened.
I had a little boy two years ago and with lots of support from the
Community Mental Health Team and Children’s Services he has
remained with me, but then I discovered I was expecting another
baby. Oh, I guess there will be those of you reading this who
might be frowning on me, but you need to walk in my shoes.
Panic set in: how can I keep my son and my new baby? I knew I
would struggle. My care co-ordinator spoke to me about Direct
Payments and perhaps employing a personal assistant who could
support me in my parenting role.
This is a story of my success and the success of Direct Payments.
Plans were put in place before my new baby came along: we
agreed my support needs and placed an advertisement in the local
paper. The Independent Living Advocacy helped me with this.
Despite this being unsuccessful two people in my support network
wondered whether they could apply.
So applications and
interviews later, I now have a personal assistant and he helps me
with lots of thing. My baby was born and I had a beautiful little girl.
The best thing is that my personal assistant helps me when it suits
me, particularly at the times of day that I find difficult, such as
getting the tea ready. I’m sure lots of you with children know what
it is like when you have hungry children all wanting your attention:
this was a difficult thing for me to manage due to my own needs,
but now things are going well.
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 5of 31
Even the financial management of Direct Payments didn’t put me
off as Essex PASS {Personal Assistants’ Support Service} sort all
of this out for me; so no worries.
It has been a success! My daughter is now 7 months old and we
are a proper family, with just a little extra help.
So the message for all of you out there is: use Direct Payments, it
has definitely helped me a hell of a lot and it has meant that I have
kept my children and I have never been happier. I get to choose
who comes into my house to help me, and when I need help.
I guess the thing to remember is that the things you do on a day to
day basis, with no worries, some of us need a bit more support
and as a Mum I needed support to help me parent my children.
Thanks to my care co-ordinator for having faith in me.
2005
Name withheld -submitted via North Essex Mental Health
Partnership Trust
Contact: Kathy Bennett
Direct Payments Development Manager
Kathy.Bennett@essexcc.gov.uk
Tel: 01245 434662
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 6of 31
DIRECT PAYMENTS
Direct Payments is intended to give disabled people, along with people who
suffer mental health problems, independence and choice in their care and
support arrangements.
My client is a gentleman in his fifties who has an Alzheimer’s type disease.
He lives with his wife, who is in her thirties, and their son of primary school
age. This client’s wife is the main carer and provides all his personal care
needs which become very demanding for her and, at times, stressful. She is
equally solely responsible for their son’s care needs.
I discussed Care Packages with my client and his carer but he refused all
intervention as he did not feel he required ongoing supported care from a
stranger. He was embarrassed.
Direct payments provided a viable option as the scheme aims to give greater
independence and an ability for he and his wife to purchase personal
assistance of their choice. My client could choose the support in a preferred
form rather than having to rely on the Local Authority `Home Help’ service or
agency care.
An Independent Living Advisor assisted my client and his wife to decide how
to manage their care needs. His wife was able to recruit his own personal
assistance in a more flexible way and of my client’s own choosing which
included personal care, along with a more creative additional social care, i.e.
someone to take him to the pub and chat with friends or play golf (a skill he
has been able to retain).
His wife is now able to attend her computer class and Bingo outings. She is
now also able to devote more care to the couple’s son’s needs and be less
stressed when their son returns from school. Direct Payments enables the
carer to look after the client whilst his wife is able, for example, to assist with
the son’s homework or school activities. The family can look forward to
weekend breaks along with respite care as a carer can now assist even whilst
on holiday if required.
In all, my client and his wife can continue to enjoy valuable time they have
together, where otherwise they would have been restricted to a resource led
service which did not meet their particular needs.
David Bond – Lancashire Social services
2005
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 7of 31
Norfolk DP use - some examples May 2005
1. Two men with mental health problems met at a mental health
service and as they recovered decided to set up a business. Direct
payments paid for 6 months rent of a small premises to get them
started.
2. One person had been refusing services and was unable to leave
their house. Through direct payments they agreed to employ
someone they trusted, and soon after contacted their care
manager from the barbers! Finding that the hair cut has made
them feel good, the person, who had very limited social contacts,
is now looking at other activities to do with their support worker.
3. A person with eating disorder, who had been in various places
to ‘cure’ her, has someone to come in for half an hour each day to
check with her on the food she has in the house – enabling her to
live her life on her own terms
4. Person lives with sister and family, and every now and then
needs a break. Direct payments pays for train fare so she can stay
with her brother. Own solution to ‘respite’, and ‘self-management’.
5. Gym attendance
6. For pottery course, with a view to future employment
May 2005: Norfolk
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 8of 31
Experiences of using direct payments
Taken fron New Directions Report – Joseph Rowntree Foundation
‘I have been on direct payments for one year. To start with I
was given 2.5 hours a week and now, since a review, I have
five hours a week. I used to attend a day centre five days a
week, but this was not stimulating and my five hours now are
more valuable than five days used to be!’
‘I use my five hours a week for shopping, lunch out, walks in
the countryside, sometimes I save it up for weekend trips, and
I do college courses such as “the expert patient”.’
‘As a result of being on direct payments I have more
confidence, I have had no hospital admissions and I have a
better quality of life. I now have people back for a meal and
cook and bake. I have the motivation and support I need to
take part in my own care.’
‘In the case of people with mental health problems, direct
payments can offer one-off solutions to a seemingly
insurmountable problem, short term payments to help
somebody during a particularly difficult period or longer term
payments for care or support.’
***
‘Some seven years ago, after experiencing barrier upon barrier,
I finally was able to gain a direct payment… Oh yes, direct
payments have been around for some time now!! However, at
the time the medical model was well and truly kicking!! That
means active!! And my physical impairment was quite visible to
the various people who assessed me. I was a wheel chair user,
and when I wasn’t I was a zimmer frame or walking stick
user!! Like I said earlier, for some reason I still experienced
hidden barriers, but what was not explicitly supported for was
my hidden impairment resulting from my mental health
difficulties.
‘At the time direct payments were viewed as available for
people with severe physical disabilities – mainly white
wheelchair users!! I look back on those days, and even now I
have to wonder how I would have managed with having both a
physical and mental impairment without a direct payment.’
Julie-Jaye Charles, chief executive of Equalities, New
Directions conference, May 2004
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 9of 31
Supporting parents with mental health problems
Example 16: Supporting parents with mental health problems
Ms Jones is a mother of two children aged 17 and 10. She has a long history
of severe mental health problems and multiple hospital admissions. After the
birth of her younger child, she was in hospital for a long time, and it was not
expected she would be able to care for her family. However, she went home
with support provided every night, and looked after her children. The agency
providing the support often sent new people, which caused her considerable
anxiety. Sometimes they let her down, and the children were distressed by the
intrusive nature of the arrangement.
Reviewing the situation, the social worker arranged contact with the direct
payments adviser.
Because Ms Jones was anxious, and finds change difficult, the process had to
be very slow. She was supported at this time by her advocate and by the
community mental health team. Gradually she gained confidence. She is
impressed with how clear the direct payments adviser was about roles and
the processes involved. She feels this is particularly important for people with
mental health issues.
Ms Jones has now been on direct payments for two and half years and says
she will never go back to her old services. She has a team of two personal
assistants plus two back-ups, providing cover every night. They have never let
her down and are extremely committed to her. She has had no hospital
admissions since she started direct payments, has gained in confidence, and
now finds that even doing the direct payments administration gives her a
sense of achievement. The children have particularly benefited from direct
payments. They have a stable family life. They know the personal
assistants well and have consistency in their lives. They have all been on
holiday for the first time as a family, with a personal assistant joining them.
For social services and other professionals involved, investment in a long
planning process, following a long period of dependency, has resulted in a
sustainable, good-quality outcome for the whole family.
Direct Payments Guidance: Community Care, Services for Carers and
Children’s Services (Direct Payments) Guidance England 2003
Department of Health
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 10of 31
Using direct payment monies flexibly
Example 12: Using direct payment monies flexibly
Mr Williams is an older man living alone who has become blind, lost
confidence and has few social contacts. He is not gregarious and does not
want to go to a day centre. He feels stressed and anxious trying to cope with
everyday tasks.
At his assessment it is agreed that his needs are to reduce his anxiety,
prepare food safely, shop, regain social activity, manage his finances, build
‘mental maps’ of his outdoor environment and have emotional support to help
regain his independence. A direct payment package of 17 hours a week
enables him to employ a personal assistant to do these things.
As Mr Williams’s confidence returns, he becomes more ambitious in his
activities. He is able to
manage his direct payment hours to ‘bank’ some time. He uses the time to
travel with his personal
assistant to visit his grand daughter in London, a trip he has not made before.
The banked hours
also pay for the assistant’s travel. He pays his own train fare.
Mr Williams’s direct payments scheme allows him to roll forward any underspend on his package. Although this is monitored quarterly, to check that the
package is working (a large unspent balance might indicate a problem in
managing the payment), amounts are only adjusted (‘clawed back’) annually,
to give him maximum flexibility.
The flexibility inherent in direct payments means that individuals can adjust
the amount they use week to week and ‘bank’ any spare money to use as and
when extra needs arise. So long as the overall the payments are being used
to secure the services they are for and the care plan objectives are met, the
actual pattern of ‘service’ does not need to be predetermined.
Direct Payments Guidance: Community Care, Services for Carers and
Children’s Services (Direct Payments) Guidance England 2003
Department of Health
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 11of 31
Direct Payments For people with mental health support needs
By Pauline Heslop
Extract from: The Advocate May 2001 pages 8 & 9
I am one of the small number of mental health service users who receive
direct payments. I am directly supported in using the scheme by an advisor
from ILSA (Integrated Living Scheme Advice and Support Service), part of the
West of England, Centre for Inclusive Living (WECIL) (See Mark, 1998). But
the use of direct payments has certainly meant that the services and support I
receive are truly user-centred, user-led and match my own particular needs.
With the money that I receive from Social Services each month (reviewed on
a 6 monthly basis) I employ 2 Personal Assistants (Pas), one to work a certain
number of hours/nights each week and the other on a “back-up” basis to
cover more urgent situations when support is needed. The actual hours of
work are flexible, and generally planned a week in advance according to what
my plans for the week are. So, for example, if I have a therapy session,
hospital appointment or merely a difficult day at work in prospect, we will
prioritise cover for those particular days. My allocation of direct payments
money will also cover any necessary administration costs that I incur, such as
providing Employers Liability Insurance, paying tax and National Insurance
Contributions, paying for someone to take charge of payroll issues, or paying
recruitment costs. Overall control of the money is in my hands, via a separate
bank account, although there are strict record keeping and reporting
regulations that must be adhered to and are regularly monitored.
The freedom that direct payment gives me is immeasurable.
 First and foremost it gives me control. I don’t have to rely on a series
of relatively inflexible community care workers, or even the rather more
preferable option of independent, yet “untried and tested” (to me)
independent advocates. I employ staff of my own choosing, who are
available when I need them most. They follow my wishes and are not
bound to distant, rigid policies to which I have had no input. And they
help me with the areas of life that I see as priorities for me, at that
particular time, rather than being restricted in the tasks that they can
do.
 Secondly, it provides me with the support and confidence to live my life
as I wish to live it, rather than being constrained by fear, lack of
confidence and low self-esteem. I now live in my own home, hold
down regular employment and have friends who do not need to worry
about also being my “carers”. I go out independently, do voluntary
work with people with mental and emotional support needs, and have
learned how to trust, albeit a cat!
 Third, it acts as a form of mental health promotion and maintenance,
rather than being part of all too familiar “crisis intervention” process,
which, in my experience, has come too late to be a very positive or
empowering form of help.
Yet for all the very positive aspects of receiving direct payments there are also
difficulties that it would be unfair not to address.
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 12of 31



First, when feeling fragile and vulnerable, the whole issue of
recruitment and selection of PA’s can seem overwhelming and
exposing. It is hard enough to ask for help (from friends or
professionals) at the best of times, but to advertise for help and expose
oneself to questions (however well meaning they maybe) about your
own support needs can be particularly difficult.
Secondly, when I am particularly distressed, for example, or placing
myself in danger, my PA’s may, at times, need to override my wishes,
which may create a difficult tension. My solution to this has been to
plan out, with each PA at the start of their employment what we should
do on these occasions and each of my PA’s has ready access to an
information file that includes: things to do to help me when I maybe
distressed, advice about what to do in a crisis situation, (including what
to pack should I need to go into hospital!), who I would prefer to be
contacted on what occasions and their contact details.
Thirdly, one has to be organised in rather exacting ways! Employees
timesheets need to be submitted in order that they can be paid on time,
receipts for expenditure need to be kept and filed, regular returns need
to be completed and monthly needs assessments reviewed.
Nevertheless, for all the pitfalls and potential difficulties, the Direct Payments
Scheme has given me a life that I could not envisaged five years ago. It CAN
work very effectively with mental health service users, and the assumption
that people could not cope because of their diagnostic label needs
challenging. I hope that other mental health service users will have the same
opportunities as me to use a truly user-centred and user-led option. It is high
time that we demanded it as one of a range of all too limited, or non-existent
choices that are currently available.
A version of this earlier article also appears in Ten High Impact Changes for
Mental Health Services (CSIP 2006)
Pauline has recently updated her pioneering booklet from 2001:
Heslop, P., (2007) Direct Payments for Mental Health Service Users
& Survivors: A guide to some key issues London: National Centre
for Independent Living
Available from:
The National Centre for Independent Living
4th Floor
Hampton House
20 Albert Embankment
LONDON
SE1 7TJ
www.ncil.org.uk
Tel/Textphone: 0207 587 1663
TypeTalk 18001 0207 587 1663
Minicom: 0207 587 1177
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 13of 31
Two early case examples from Mental Health training in Essex,
2002/3
Example 1
Mr X is 63 years of age and lives in the south east of Essex. He was
diagnosed as having Alzheimer’s after a traumatic period, which came to a
head after he was found wandering along a busy dual carriageway. Mr. X
was admitted to a psychiatric unit.
Mr, X had his own home, but had previously lived alone. His Alzheimer’s
caused confusion and significant memory loss. Mr X was very clear that he
wanted to return home.
His needs were assessed as:
1. He needs to be supervised constantly because left to his own devices
he had a tendency to wander away from his home. One of the
symptoms of the dementia has been that he suffers from being
disorientated in places and is not aware of the danger posed by traffic.
2. He needs to be monitored for signs of mental deterioration and
physical neglect. The onset of the illness was very sudden and meant
that he was unable to cook for himself and had lost a considerable
amount of weight as a result. He needs a carer to ensure he eats
properly and does not neglect himself, as well as to prompt him around
matters of health and hygiene.
3. A symptom of the illness is that he tends to confabulate in his speech
which at times can appear incomprehensible to someone who does not
know him. Consequently he is not always able to communicate to
others what his needs are. The carer is there to ensure that his needs
are fully met, despite any problems that there might be with the client
communicating need.
A 24-hour care package was arranged to support Mr X to return to his own
home with a private agency using direct payments. Mr X was able to read
and understand the direct payment contract. An enduring power of attorney
was arranged to enable Mr X to continue with his direct payment even if his
Alzheimer’s worsened.
Essex County Council agreed to meet the full cost of the 24 hour care
package of £550 per week, for a time limited period while an application was
made to apply for disability living allowance (DLA). The higher rate of DLA
care component enables individuals to apply for the Independent Living
(1993) Fund.
Mr X’s DLA application was successful and he was awarded the highest rate
of the DLA care component. The ILF assessed Mr X and agreed to fund part
of his care package jointly with social services.
ILF contribution
£353.95 per week
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 14of 31
Mr X’s contribution towards his ILF package
The local authority contribution dropped to
£ 19.16 per week
£247.04 per week
The total cost of Mr X’s care package is
£620.15 per week
Mr X is very happy at home. The direct payment has enabled him to leave a
psychiatric unit and return to his home, living independently and safely. He
has been able to develop a strong relationship with two 24-hour personal care
assistants who support him on a week on week off basis.
With Mr X’s agreement the payments are made to a third party: both for ILF
and social services monies. The third party relieving Mr X of this additional
responsibility, they complete the paperwork and pay the bills.
Example 2
The second example is a service user who suffers from bi-polar disorder
(manic depression) and also suffers from a physical condition affecting her
muscles. She also had panic attacks at various hours of the day and night.
She is aged 50+ and lives alone in a remote village. Her needs revolve
around the symptoms and effects of her illness. Her physical illness reduces
her ability to carry out domestic tasks, which have in the past caused her to
neglect herself and her home environment. Her mental illness raises
numerous needs, as when depressed, she withdraws and neglects herself.
When in a manic state she will spend and give away money and has been in
sexually vulnerable situations. In both states her debts and finances have not
been addressed, the panic attacks often cause her to call her neighbours,
local GP, or the mental health team; she does not eat regularly and stops
taking her medication, this has led to relapse and hospital admission either for
her mental health condition or her physical illness.
The local mental health team has been supporting this service user by use of
a community support worker visiting three times a week and spending
approximately two hour with the service user. The support worker would
support the service user in carrying out domestic tasks, shopping, paying bills,
transporting to appointments and monitoring/reminding the service user to
take medication. Additionally a community psychiatric nurse visits every two
weeks and a social worker visits monthly and acts as the care co-ordinator.
Despite this regular input from professional staff there was a steady increase
in this service users’ needs. The peaks and troughs of her illness meant that
the mental health team needed to change the care plan regularly. Coping
with panic attacks became a major issue at one time. While carrying out a
review a neighbour was involved, she was a close friend and was often called
upon by the service user at times of crisis. The neighbour and the service
user had been discussing the support and care with the social worker, the
neighbour said she would be willing to provide more support but could not
afford to give up a part-time job doing domestic cleaning. The issue of the
direct payment was discussed and the neighbour volunteered to be a
National Social Inclusion Programme – Direct Payments
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robin.murray-neill@csip.org.uk
Page 15of 31
personal assistant. The service user eagerly accepted this offer. After further
exploration, looking at the pros and cons and independent advice from ILA
(Essex), it was decided to make an application for direct payment and this
was duly accepted. Essex PASS administers the finances, thus taking the
stress from the service user and ensuring that finances are consistent and
that the personal assistant is paid appropriately and regularly.
This has proved to be a major innovation and a turning point in this service
users’ care. Panic attacks have reduced; medication is taken more regularly,
no admissions to hospital for one year. The service user presents as happier
and the peaks and troughs have lessened and are less severe. The reason
for this change would seem to be due to the trust, consistency, and having
someone geographically near. This gives her a sense of security and the
amount of time spent with the service user can be increased. It was taking
the support worker forty minutes to get to the service user and another to
return, so one can see that a half day could easily be used for this one user,
multiplied three days a week, minimum.
There are issues that have to be addressed when considering such an
arrangement, that is, that of holidays for personal assistants and cover, over
reliance on the PA, stress, the lack of confidentiality etc. However in this
case, the care package arranged through a direct payment has enabled the
service user to have a service that she is happy with, which gives her quality
of life and reduction of difficulties previously experienced by her. This in itself
makes direct payments worth considering.
These two examples give a ‘taster’ of what could be achieved with direct
payments. It is important that service users and carers are not “put-off” by the
administrative aspects of direct payments and professional staff not deterred
by the process or criteria. Meeting service users’ and carers’ needs in this
way can be very successful and creative but requires assessments including
risk assessments and care plans to be very clear. Used properly, it is
possible to achieve improved user and carer empowerment in mental health
together with quality outcomes and best value.
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 16of 31
Mental Health service users and direct payments – our experience
working with users/survivors of the Mental Health system.
Maureen Harris, DP support worker and mental health service user.
Southampton Centre for Independent Living (SCIL)
Our organisation:
We are run and controlled by disabled people based on a peer
support model with 20 years experience in the development of
direct payments and the self-operated care schemes that
preceded direct payments (DP’s).
My role was created as part of a national pilot looking at ways to
increase the number of Mental Health (MH) users using DP’s.
SCIL & Hampshire County Council have a history of partnership
working to find ways of improving DP’s and particularly the
diversity of users
Key success factors
Peer based support means MH users are more likely to see how
they could benefit from DP’s when the message is delivered and
support offered from someone they can directly relate to.
“If she can do it, maybe I can too”
Other success factors
It is important that MH practitioners see the benefits of DP’s; see
real examples of how they can work and are linked closely to the
support service. This helps practitioners see the value of giving
control to users and taking a pragmatic approach to risk taking
Knowing that support for the user and practitioner is available
has helped to identify and promote good practice. We have also
managed to get practitioners who have seen value of DP’s to
inform and educate their colleagues
The following are some of our key findings:
DP’s offer people with mental ill health the opportunity to regain
control of their lives and support recovery. They have also enabled
access to services that may not be available otherwise (e.g.
suitable service not available, travel too great, MH user not
wanting the label that traditional services have placed on them)
National Social Inclusion Programme – Direct Payments
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Page 17of 31
They have promoted innovation – creative and individual solutions
to meet individual needs
Some barriers
MH users can be seen as more vulnerable to abuse and need
easy access to CRB checks.
Some people may have high/ongoing support needs, particularly in
retaining staff.
There can be some issues with communication &
management of PA’s. Contracts of Employment need
to be very specific to prevent boundaries being crossed
e.g. one woman has had 10 PA’s as finds it difficult to
maintain boundaries, she feels PA’s take advantage of her.
Needs much support in maintaining relationships
Finances, bank accounts and record keeping can be difficult as
users with enduring MH issues can sometimes get into financial
difficulties.
A support worker can help by having knowledge of co-operative
local banks and able to offer support with difficulties.
Mental Health culture needs to change
We still experience practitioners/providers reluctant to allow users
to take risks and the risks are often exaggerated. Practitioners
believing they will be responsible if it goes wrong
Real empowerment only happens when users are ‘allowed’ to take
risks backed up by supportive/pro-active practitioners. It is also
essential to build on the successes and for others to learn from
these successes.
We need a commitment of service providers to promote selfdetermination. The perceived impact on existing services may stop
DP’s being promoted – therefore users don’t get to know about
alternatives to existing services.
It is VERY IMPORTANT that the support service has links with
National Social Inclusion Programme – Direct Payments
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Page 18of 31
local user groups to enable peer support to promote DP’s.
What we do in Southampton
We developed a specific information pack for MH users. The
support worker also does as many home visits as necessary and
assists to support SELF ASSESSMENT which is critical too.
Providing support/advice/information to practitioners with regular
awareness based training has been helpful. We have also
encouraged users to give advance directions as to what they want
to happen during a crisis; who to contact; what to do etc
What DPs have been used for in Southampton
Help around the house, Domestic Support, with social inclusion,
support with finances; going to appointments, Equipment –
including computers.
Arts – innovative use in supporting groups of people to use arts to
meet needs and other leisure activities,
Childcare
Respite
In conclusion
DP’s work very well for MH users/survivors Peer based support will
be critical Innovative approach to meeting needs
Need practitioner ‘champions’ for DPs
Most of the ‘excuses’ for not allowing DP’s for MH users are the
same ‘excuses’ that have been used for people with physical
impairments – they were disproved for people with physical
impairments and history WILL disprove them for MH users
From National Centre for Independent Living website:
http://www.ncil.org.uk/Ind_JAug05.asp
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 19of 31
Comments about Direct Payments by CW
I have found this service very helpful Direct Payments has provided a
companion who I get on very well with, we do various things together eg
swimming, snooker, pictures, shopping we also go for a drink together.
More than anything Direct Payments has given me choices and has
helped no end with social inclusion, … my companion has introduced me
to new friends and I am finding it far easier to socialise with people, my
family have also noticed that my social skills are improving .all of the
time. I would not hesitate in recommending Direct Payments to other
Service Users, Direct Payments opens doors and improves lives.
C J W, direct payment user, Thurrock
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 20of 31
MIND YOUR HEALTH – with Direct Payments
Taken from: DP News: The Independent Voice of Direct Payment Users. Issue 13, pages 5-7,
December 2005, Richmond Users’ Independent Living Scheme
Mental Health service users benefit from using Direct Payments (DP), we
see how one person overcame his worries to achieve greater well-being.
People experiencing mental health problems talk of surviving but nowhere
near realising their potential or contributing what they could in terms of
employment, family life or to the wider community. Well, this is where Direct
Payments can help, but lets get a mental health survivor to explain;
“Hi, I’m Mark. With the money I get from my Direct Payments(DP) I employ
two support workers or Personal Assistants (Pas).One works several hours
each weekday or night and one acts as a ‘back-up’ to cover any periods when
I have a particularly difficult or stressful moment. The times my Pas work are
down to me, as what I can and want to do varies. They follow my wishes and
are not restricted by any one else.
Mark’s comments gives an idea of why DP can benefit people with mental
health problems (see also Examples 1 and 2 below). He referred to the choice
and control that he has over the support he receives and to the fact that his
personally tailored, one-to-one, regular but flexible support is largely selfmanaged and directed. This in turn has helped him regain confidence and self
esteem, to get away from a reliance on drop-in services that he felt were
segregated and stigmatised, to access other support that was not available
otherwise and ultimately, to help him become more involved with his family
and local community.
“It’s all too difficult and complicated”.
But, Mark also had concerns that explain why the take up of DP remains low
amongst other mental health service users, namely, the worry that; “It’s all too
difficult and complicated”. Here’s what he said;
I’d be lying if I said that there are no worries about using DP. When I was
interviewing strangers for the job of my PA, I felt a bit down and vulnerable
and I didn’t fancy talking about myself to others. The idea of having to pay
staff, and do paperwork was also something I didn’t fancy but, now I’ve found
ways of coping and I have a life that is much better than it was. With my Pa’s
help, I’ve got some of my old confidence back and have started voluntary
work and going out more.”
This concern would flood his thoughts particularly when he felt fragile and
vunerable, yet his fears became less once he met his Independent Living
Advisor(ILA). She took him, step-by-step, through setting up and managing
his DP. The ILA (togethet with an informal circle of supporters) was also on
hand to help with such practical things as opening a bank account and
interviewing ‘job seekers’. Mark’s ILA also set up a free payroll service that
calculates his staff wages and issues their payslips.
National Social Inclusion Programme – Direct Payments
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Page 21of 31
“Some days I’m good and but on others …….!”
Mark’s fears as to what happens at “a particularly difficult or stressful
moment”, have also been addressed by his DP advisor. But let’s get him to
explain;
“When I’m particularly ‘low’ I can place myself in danger but at such times, I
have agreed with my Pas that they should follow a set plan that was agreed
with them when they first started working for me.. This records what (and what
not) to do, who to contact and anything else they should be aware of at such
times .”
Called an Advanced Statement, this pre-planned and agreed written
instruction record Mark’s wishes and any arrangements he wants to happen if
he felt unable to decide or deal with them at some time in the future. Mark’s
Statement is written in clear everday language and includes such things as;
signs that show I’m unwell and what to do, who is to handle my finances
(including the spending of Direct Payments), what, where and when to give
me medication, what to pack should re-admission into hospital be necessary
and who should look after my dog!
The fact that Mark has ‘good’ and ‘bad’ days has also been accommodated
by; only employing support workers who are able to work flexible hours,
having a support back-up plan and knowing that, should all else fail, his local
authority has a duty to step in and help if his DP arrangements break-down.
“A risk to myself and others?”
Mark’s initial concerns about DP could have stopped him going ahead but
fortunately he had a Care Manager/co-ordinator who believed in selfdetermination, who consulted Mark at all stages, took account of all aspects of
his life and adopted a practical approach to the management of risk.
The Care Manager realised that if Mark was to have a chance of recovery, he
had to be allowed to take risks but that sensitive and well-planned support
would help make this a practical and calculated option. So, for example,
Mark’s Independent Living Adviser (ILA) was brought in early to help set him
up with; employer’s insurance cover; a set of ‘house rules’ an Advance
Statement that Mark wanted all his support workers to follow; a job description
and contract of employment that were specific to Mark’s situation and would
help prevent boundaries being crossed and effective working relationships
being maintained. These measures, together with appropriate monitoring
reviews, gave the Care Manager sufficient reassurance that Mark’s best
interests and assessed needs were being met and that greater choice,
freedom and control kept Mark in the driving seat or as Mark himself says;
“………my Direct Payments scheme has given me a life that I could not have
imagined five years ago. I just hope that other mental health service users will
have the same opportunities as me”
continued…
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 22of 31
Direct Payments that work
Example 1
…… a young woman with a history of continuing self-harm also has difficulties
sleeping, and will often feel unsafe and vulnerable at night. She uses her DP
to employ someone to give her night sitting support. The PA does household
tasks while the young woman sleeps, but if she has a disturbed night, her PA
will sit and talk to her, thus reducing her feelings of isolation and the incidence
of self-harm.
Example 2
……a single mother of teenagers whose history of mental ill health and
frequent hospital admission was threatening the stability of her family, was
offered Direct Payments. Her level of anxiety is heigthened by change so her
advocate and community mental health team, together with the Independent
Living Advisor, gradually introduced a package of daily support that employs
the services of two personal assistants and two ‘back-ups’ to provide cover at
night. Careful planning and gradual introduction of support tailored to the
mother’s needs has resulted in a sustainable, good-quality outcome.
Richmond Users Independent Living
Scheme (RUILS)
Direct Payments Users Group provides help in recruiting PA (care) staff, DP
newsletter, training for users, meeting other DP recipients and representing DP
user’s views.
Tel: 020 8831 6083/4
Email: info@ruils.co.uk
Web: www.ruils.co.uk
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 23of 31
STEPPING ON OUT
Taken from: DP News: The Independent Voice of Direct Payment Users. Issue 14, page 3,
May 2006, Richmond Users’ Independent Living Scheme
[An example which has a broad relevance, including for people with mental health problems]
An exciting new project that uses Direct Payments to give local
disabled people a chance of running their own business!
Six people with learning disabilities (PLD) are using their Direct Payments to set
up a small business making and selling cards, gift wraps, second-hand books,
videos, CDs and tapes around Richmond.
By ‘pooling’ their Direct Payments the group can afford the salary of a Project
Coordinator to work 3 days a week, to help them run their business, organise
their production, sales, marketing and business support.
The development worker will be legally employed by the Trustees of the
‘Stepping Out’ Project so the PLD team will not have to worry about employer
responsibilities. However, they have been involved in all aspects of the decision
making process from deciding what they will do, writing a job description and job
specification and working on their own interview questions.
Candidates for the post of development worker have been interviewed by
members of the PLD team and it is hoped that someone will be in post by the
beginning of May. The Project will work with both ROWAN and RUILS to ensure
that appropriate record keeping and money management is maintained, whilst
Richmond Adult College will offer a range of educational opportunities linked with
“on the job” training.
‘Stepping on Out’ is an innovative, community-based non profit making
organisation that is run by people with learning difficulties, uses Direct Payments
in an imaginative and flexible way and provides effective and fulfiling
opportunities for adults with a learning disability to develop essential skills and
the work experience needed for future employment!”.
As Jackie Pilcher, the DP advisor says; “This is a unique and radical new way of
using Direct Payments to provide gainful employment for people with learning
disabilities outside a day centre or college environment. It is a model which can
be used by other disabled people, not only in Richmond, but in other boroughs
and other areas.”
For more information on the project contact:
Simon Josolyne from the Trustees: steppingonout@hotmail.co.uk
or Jackie Pilcher, 07968 204846 from The ROWAN.
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 24of 31
Examples of how Direct Payments have been used by Devon Mental Health
Service Users and Carers.
Detailed below are current examples of how Devon service users and carers have
utilised Direct Payments during 2005-6. This paper is written with the expectation
that this may encourage others to consider taking up Direct Payments as an alternative
to contracted services through Devon County Council.
1. DP’s for both a personal assistant and a live-in carer
Direct payments are used to pay a personal assistant for 12 hours per week to provide
a service for an individual who suffers from obsessive compulsive disorder. The
person’s needs require supervision in the areas of dressing, washing, bathing and
other personal needs. Other areas of need requiring less intensive help are those of
eating, drinking and administering medication. The service user also has a live in
carer who provides care and support outside of the hours that the personal assistant is
employed. The carer now also receives direct payments for 4 hours per week to
enable her to have a break from her caring role. This is enough time to allow her to go
into the local town and have some time to herself. The person she cares for does not
go out and the carer finds her role stressful and tiring.
2. Help for a parent with mental health problems
Ms B has borderline personality disorder, depression and seasonal affective disorder.
Some days she is able to manage the activities of daily living, other days she is unable
to manage anything. She is married with 2 children, the eldest having severe autistic
spectrum disorder. She often does not cope and will take herself off to bed. Her
partner cares for her and the two children when she is not well however is self
employed and finds coping both an emotional and financial strain. Direct payments
are used to provide additional help in the house and childcare support. This is a jointly
funded arrangement with the child care team.
3. Enabling a live-in carer to take a break
Mr M has paranoid schizophrenia, diabetes and physical disabilities, some sustained
as a result of his schizophrenia. He lives with a close relative in her 70’s who is his
sole carer. Mr M has difficult to meet needs due to the nature of his illness and local
community resources are not appropriate for him. Mr M has considerable needs
around personal care, provision of meals, medication administration and clinical
appointments, management of risk and his monitoring his mental state. Direct
Payments are used to employ an assistant from an agency to provide support to Mr M
specific to his needs. This allows the carer to have a break from her caring role as well
as providing some specific time for Mr M that is acceptable to him and meets his
specific needs.
4. Enabling family contact for a mother living in residential care
A woman who lives in residential care is enabled to have access to see her son
through the use of Direct payments. Mrs Y has lived for 2 years in a small 6 bedded
Residential Home some 20 miles away from where her son resides with his father and
his partner. Since living in residential care Mrs Y has not been able to have regular
contact with her son. Mrs Y has only the standard pocket money benefit living in
residential care and due to her level of mental health problems is not currently able to
manage public transport such as train or bus without assistance. Direct Payments
National Social Inclusion Programme – Direct Payments
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Page 25of 31
enable Mrs Y to have fortnightly contact with her son. This is with the aim of
improving the quality of her life and enabling her after a gap of nearly two years to be
a part of her son’s family network. The Home will provide a worker to accompany
Mrs Y to collect her son and have made a room available for their use within the
Home. Mrs Y will use her residential allowance to enable her and her son to access
local community resources. It is expected that this will have the secondary benefits of
helping Mrs Y improve her self confidence and gain lost skills in interacting with
others, taking on more responsibility and becoming more self reliant.
5. DPs to enable access to community facilities
Mr J is married with a wife and children. He has a nine year history of severe mental
health problems including those of suicidal ideation and difficulty in managing his
emotions. The only recreation that he has found that helps him to self manage his
mental state is attending his local gym to exercise. Direct Payments are used to
purchase a subscription to the gym so that he can access this daily and maintain his
mental health without major risk.
March 2006
Sherrie Hitchen,
Social Care Modernisation Manager
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 26of 31
Direct Payments from Viewpoint News Spring 2007
Any recovery story will have many strands to it. In this piece I will concentrate
upon Direct Payments. I fully appreciate that without the support of friends
and family and my gifted surgeon, my health could be so poor that no amount
of money would compensate.
My Direct Payments involvement stemmed from reading the social work
pages of “The Guardian”. Here I found an article about a Huddersfield-based
group of disabled people who were organizing their own care with financial
assistance from the local council. This was relevant to me as I had a hip injury
which was restricting my movement and compounding my mental health
issues. I am a bi-polar - this is manic-depression in old money for any reader
without a clinical background. The major way in which this combination of
disabilities restricted me was that willpower and motivation were required to
complete even the simplest task. As an independent minded (to say the
least?) person I was immediately attracted to Direct Payments whilst viewing
the complexities of the employment legislation aspects with some concern.
The second stage of my involvement was to learn as much as possible about
Direct Payments, mainly using the internet. I discussed my idea with my social
worker who, in a bold move, arranged for me to attend a staff training day. At
the training day I met the mental health lead for Herts Partnership Trust and
the county lead; a good day’s work. This training was key. It showed me for
the first time that Direct Payments could be used in a purely mental health
setting. Armed with the knowledge that this subject would not lose its
relevance for me upon my hip being fixed, I continued trying to master the
intricacies within.
Just in case you are unfamiliar with Direct Payments, I will explain. If you are
receiving social care it is possible to get money to either help you domestically
by employing a carer or to use to arrange your own activities. If a person is
employed all the red tape of employment legislation must be adhered to. In
the simpler model all that is required is that receipts are kept so that
everything is legal and above board. There are restrictions upon how the
money can be spent; no drugs, no booze, no wine, no weekly shopping, no
consumer goods among others.
It is not standard practice to spend almost two years studying Direct
Payments before applying. The paperwork is very simple and the last I heard
was that county can turn an application into a monthly supply of cheques in a
short time. I have been receiving payments for just short of six months now. I
find that I even enjoy the administration of the money spent. I use the money
to work on my fitness and for the occasional night out.
My personal experience of Direct Payments is that it works. It has provided
me with the means to take up new interests as well as being an interest in
itself. Dr. Samuel Johnson said if you are tired of London you are tired of life: I
will never tire of Direct Payments.
Andy Smith
www.hertsviewpoint.co.uk
HERTFORDSHIRE MENTAL HEALTH SERVICE USER INVOLVEMENT CHARITY
E-mail: info@hertsviewpoint.co.uk
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 27of 31
Direct Payments – a great opportunity and a cautionary note.
Lynda Waterson
I want to sing the praises of Norfolk and Waveney Mental Health Partnership
trust, and how they have got their act together re Short Break direct
payments. However, I also want it to be clear that whilst I have greatly
enjoyed the opportunity to go, if like me you are a person who is liable to be
assessed for charging for the services you receive, then you might have to
pay some of the direct payments back!
I decided that I could attend the study week in Cornwall that my part time
course offers if I could find a carer to come with me. (this was very last minute
as I had assumed I wouldn't be able to go)
I told my CPN I'd like to apply for a Short Breaks payment on Friday 21st April
2006 to go to Cornwall 8-13th May. She phoned me back, we completed the
paper work very simply, and
on Wednesday 26 April a cheque for £200 ARRIVED - less than a week!
I then got a letter from Norfolk County Council Social Services saying - 'I am
pleased to welcome you to the Direct Payments scheme...' It went on to
explain I need to keep receipts and how to fill in the enclosed expenditure
monitoring forms.
This letter also explains that once your income has been assed you may have
to make a contribution. Of the £200 I was given for a weeks break they have
assessed me to contribute £116.05p.so I've had to give that much back.
Having accepted that fact, I still feel that this is service improvement which
deservers a
!!!!!!!!!!!!BIG CHEER!!!!!!!!!!!
Lynda
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 28of 31
Direct payments for short breaks (‘respite’) in Hertfordshire
- a few examples.
A mental health user went to India for 2 weeks
An older user employs an agency carer to escort him to another relative - the
respite money pays for the carer’s time and rail fare
A gentleman with a brain injury has just come back from Butlins - he went with
a friend. His wife is the main carer and needed a break from caring, but he
decided residential care is not suitable for him
Another gentleman uses DP to go fishing. This man has been assessed as
needing 4 weeks respite, to give his wife a break, but in fact uses them for
long weekends 3/4 days so gets 7 or 8 (shorter) breaks a year which suits the
family situation
Another one (although done through carers grant) was a woman who paid for
her relative to come over from Australia to give her husband a break from
caring for her.
These are only brief details and I’m happy to provide others
Angela Robertson,
Principal Officer, Direct Payments,
Performance and Workforce Development
Adult Care Services,
Mount Pleasant, Hatfield, Herts, AL9 5PU
phone 01707 280684,
comnet 20684
mobile 078818 54591
e mail: angela.robertson@hertscc.gov.uk
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 29of 31
Direct payments to carers in Poole - two examples:
1. A contribution to a carer’s counselling supervision costs. She was
undertaking a diploma in counselling with a view to future employment
as well as her own personal development. The counselling supervision
was a course requirement, but would otherwise have been difficult for
her to afford as the family were reliant on benefit income.
2. A contribution to the cost of domestic cleaning for a carer who was
extremely busy with the demands of a young family and a struggling
business as well as her caring responsibilities (the person for whom
she was caring was acutely unwell at the time). This enabled her to
have a little time to herself.
PRO Disability (the direct payments administration service in Poole) were
incredibly helpful in steering me through whole process of setting up direct
payments. They were also involved in some helpful staff training/awarenessraising.
Alison Mesher
Carers Officer
Poole Community Mental Health Teams
(01202) 305062
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 30of 31
Direct payments and Social Enterprise: Stepping Stones Café, Falcon
Lodge Community Centre, Churchill Road, Sutton Colefield
[Another example which, as Suzanne suggests, has a broad relevance, including for people
with mental health problems]
Stepping Stones Café is a healthy option project that enables those with a
learning disability to have experience of a real working environment. This
project is set in the community, for the community, to meet the needs of the
community. The project has five people with learning disabilities, two of
whom are in receipt of direct payments which enables them to bring their own
support worker. There are also three unpaid support workers. The project has
had opportunities to also do outside catering at weddings and other functions.
This project was only made possible because my daughter was in receipt of
direct payments. I was able to support my daughter to make use of the
payment in an innovative way and through this three other people were able
to access the project. This has also allowed the participants of the project to
mix in the community in a positive way. This particular project also allowed
the participants to learn catering skills and acquire a food and hygiene
certificate.
We feel that this type of project could be replicated elsewhere. There are
other projects which could be set up using the same formula for direct
payments being used to support the person with a learning disability. This
gives the person a sense of self worth and also the opportunity to work with
others and mix socially. We can also see other possibilities of bringing
together people with mental health and other disabilities on projects like this.
We are now working towards becoming a charity and this allows us to access
other funding from grants and trusts.
Positive Aspects
 New skills – catering, serving as waitress, food and hygiene certificate
 New relationships with each other and other support workers
 Serving the community
 A growing confidence has been noticeable in the participants
 Meaningful focus to their week
Negatives Aspects
 Initially a need for parent/carer involvement which would not be possible
for everyone
 Finding suitable qualified cook to oversee the project
 Finding the suitable support to create a social enterprise
Recommendations
 Where social enterprises are set up through direct payments and offer that
service to other people with a learning disability who are not being paid
direct, the local authority needs to recognise and make some financial
payment available.
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk
Page 31of 31

Need for networking of people with direct payments and their
parents/carers to exchange possible ideas to generate good practice
Research
 What other good models are there of social enterprises being established
through the use of direct payments, with the support of parent/carers?
 Would social enterprise be allowed in all local authorities?
Suzanne Coward (C/o Robin at the address below)
And Finally…
In Essex, direct payments are being used to enable a person to travel to
pursue their interest in animal care
To be continued…
Extract from Using Direct Payments in Norfolk’s Integrated Mental
Health Services: Implementation Guidance to all Care Managers / CPA Care
Co-ordinators / Locality & Team Managers (2004) Norfolk and Waveney
Mental Health Partnership Trust
i
ii
Department of Health (2003) Direct Payments Guidance: Community
Care, Services for Carers and Children’s Services (Direct Payments)
Guidance England 2003 September 2003 London: DH
iii
Spandler, H and Vick, N. (2004) Direct Payments, Independent Living
and Mental Health: An Evaluation Full Report. London: Health and Social
Care Advisory Service
iv
Newbigging, K. and Lowe, J. (2005) Implementing Direct Payments in
Mental Health: New Directions Brighton: Pavilion/JRF
National Social Inclusion Programme – Direct Payments
Contact: Robin Murray-Neill 01206 287588
robin.murray-neill@csip.org.uk