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| Mental Health and Self-Direction: A Shift in Power |
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Self direction shifts the power in treatment and recovery plans from providers and professionals directly to the individual who experiences mental illness or the family of a child with serious emotional disturbance. Self direction facilitates the development of personal goals and objectives that allow the individual or family to control the public and private resources necessary to purchase those supports and services central to the success of the plan. The individual's goals and objectives are used to design a plan to recovery. In this paradigm shift, professionals and providers become helpers and resources for the person, rather than the ones who narrowly define treatment options and press individuals with disabilities to select those options. Ideally, this fundamental change in power recognizes the primacy of the person who experiences the disability and changes the role of providers to a more respectful role that honors personal plans of recovery. Peer support can become another resource for individuals who need assistance in formulating and purchasing their unique plans of recovery.
Self Direction and Self-Determination
It is helpful to think about self direction under the header of self-determination-a wider philosophy designed to assist all individuals who experience a disability to achieve a meaningful life in their community, filled with important human connections and relationships and, among other important life issues, seek financial security and income. (See self-determination.com). This foundational movement of self-determination provides for a more holistic personal plan that incorporates the notion of recovery within a life plan filled with high expectations. Self direction then moves from narrow treatment options to encompass issues important to the person served in the process of realizing both recovery and a full life. It is based on a set of principles for reforming systems of behavioral health and a new set of tools to restructure this system.
Principles of Self Direction/Self-Determination
Freedom to decide how to live one's life and develop recovery strategies and life goals based on universal human aspirations and personal ambitions.
Authority to control the dollar resources in order to make purchases and expenditures that advance both recovery and life goals.
Support for highly personal and unique plans of recovery that allow for purchases both within traditional services and from the wider community as well.
Responsibility for using public dollars wisely, decision-making with freely chosen assistance when needed and for becoming a contributing member of one's community.
Confirmation of the important role that persons with disabilities (and families when appropriate) need to have in restructuring the system of supports and providing leadership.
Tools of Self Direction/Self-Determination
Person Centered Planning is a planning process that is controlled by the person with a disability (family for children) that results in a recovery plan that details the issues important to the person and is managed in all important aspects by that person with freely chosen support when necessary. This recovery plan also spells out what will constitute both quality in the execution of the plan as well as specific outcomes sought.
Individual Allocations and Personal Budgets are the amount that is under the person's control and the line item expenditure plan developed to carry out the person centered plan for recovery.
Fiscal Management Agencies are organizations that hold the individual allocation for the person and pay bills, taxes and benefits based on an approved individual budget. They report regularly to the funding authority and to the person with a disability and relieve the person with a disability of worries about federal, state and other tax and benefit liabilities. In some cases they may perform other functions including being the employer of record.
Independent Brokering/Peer Support is any arrangement whereby another person provides competent and unbiased assistance in the development and execution of personal plans of recovery
In all respects the "tools" enumerated above need to be conflict of interest-free, recognized as authoritative structural replacements to the present system and function seamlessly for the person with a disability and family. As well, these tools must reflect an approach to quality that addresses issues of health and safety and fosters personal quality of life dimensions as well as improved services-subject at all times to the personal selections made by individuals with disabilities.
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