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Archive for October, 2016

Personal Health Budgets for Mental Health – Part 2

28 Oct

This is an update after the recent post about personal health budgets in mental health. I met with both my care coordinator and woman from the health budgets department and it was decided that we should have a meeting with them as well as my therapist as my support was to be psychologically driven and so needed her input. 

When we all met the following week, we discussed how better my needs could be met based upon my health goals:

1) better crisis support to reduce a&e visits

2) support network around therapy as this was going to get difficult over the coming months when we start trauma work. 

3) help to get back to a fitness regime which was a big part of my life before everything happened. 

4) psychological help. 

In order to meet these goals we tried to think outside what the current NHS provides and so came up with the following:

1) Crisis support similar to a residential setting but without actually staying anywhere else – so having access to a service 24 hours a day as nighttime is my worst time and at the moment, I am advised to go to a&e at these times. 

2) A support worker twice a week to try and integrate me back to a standard of living and not just existing. Hopefully this will allow me to start getting out and doing things like shopping – simple tasks that just aren’t doable right now. 

3) A personal trainer twice a week to help me with my health and fitness goal to lose weight and hopefully reverse a recent type 2 diabetes diagnosis. 

4) Psychological trauma work to overcome my ptsd symptoms and move forwards. 

I must admit, I’ve found the whole process rather stressful which I know is because I’m the first in the area to do this and so a lot of questions are being asked for the first time and I’ve not really had anywhere to turn for advice on what others have done in my situation or similar. The good thing though is that I’ve realised my care coordinator and therapist both totally understand what I need in order to move forward and this has given me some renewed hope that I can get through this and maybe have a chance of a ‘normal’ life. I’ve definitely learnt however, that there is no way you can try and do this process alone, you need the help of professionals who know your situation.

I think when I was first told about this new way of working, I was worried that it essentially meant stripping away everything I was currently receiving and then buying in services. It really stressed me out thinking I would be losing relationships that I’d spent time and effort building and could I really go through all that again. I’ve since learnt that I can keep these things, like therapy, and the additional support is to help reduce costs elsewhere (like the use of a&e). I think this needs to be made more known at the outset to relieve any potential worry. 

The actual process seems a bit in the air right now, with some parts seemingly a bit backwards. For example, once you receive an indicative budget, you are able to meet with a broker to help fulfill the goals in the support plan. However, the support plan asks for information that would seemingly come from a broker so that bit had to be left unanswered. There was a lot of repetition as well in the forms and I’m not sure they are right as they currently are. 

The process though has been well communicated to me throughout and I can’t fault the people involved (my cc, therapist and woman from personal health budget department), it just feels like everyone is on a learning curve right now. Hopefully this is the start of things changing for me. 

Moving forward now, I’m not 100% how things will actually work out as I don’t know if there is anything out there that can be commissioned to meet the crisis care goal. I guess this is where the broker will come in and be able to help find anything out there. It’s quite a slow process so far, we started in back in August and so I’m not sure when these things will be actually put in place. The only downside I think is that I feel under pressure not to use a&e, like I’m wasting resources. To be honest, like most people with mental health issues, the last place they want to go in a crisis is a busy a&e department, but what other option is there? It’s where we are told to go repeatedly when out of hours. I’m hoping that this will provide me with an alternative, but what if I’m incredibly suicidal, will the crisis place not also just tell me to go to a&e? Will this actually work? I guess time will tell, but my personal concern is that I won’t speak up in crisis because I don’t want to use resources that are above and beyond the budget. Will this end up in me just being actively suicidal and in a lot of danger? I guess only time will answer these questions. 

 
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Memories

11 Oct

Ok, this is a bit of a weird post to write and so I’ve no idea how it’ll come out in words, but let me try!

I’ve been thinking a lot about my childhood recently for some reason and with this, the concept of memories. I guess what I want to know is how does a memory happen for you? 

For example, I can be reminded of something that happened when I was younger and it’s like looking at a picture of it. It happened, I know it did but I have no emotion attached to it at all – is this how others recall memories? 

Some timeframes are completely forgotten about, like I don’t remember birthdays but I know after a certain age that they were ok so it’s not just about hiding bad emotions. I don’t connect with good emotions either. I’m not sure I’m explaining this very well. 

Some memories I know happened as I can recall them (and no one else had told me them), but I don’t actually have the full recollection, as in I can’t fill in any surrounding details, I just know it happened (this is usually around bad memories). 

I just assumed that this is how everyone remembers things but is it?

 
 

Personal Payment Budgets for Mental Health

06 Oct

My area has just introduced personal payment budgets within mental health (it already exists for social and health care). This means that basically they look at how much you have cost the system over x amount of time and then allocate you a budget to spend on services that can best support you in order to reduce the overall cost. Sounds ok on paper doesn’t it but I’m part way through the process as the first person in my area and I’m getting a bit stressed by it all.
There are many questions I have but no one within my community mental health team knows the answers because it’s brand new.

I had to submit an expression of interest form which looked at my goals to get better. I took a three point approach:

1) receive psychological help

2) receive support when in crisis

3) receive support around weight loss and health goals to enable me to feel more confident to go out

This was taken to my local Clinical Commissioning Group (CCG) who have said it needs more information before releasing funds. I am therefore meeting with my care coordinator and the woman in charge of the process to try and put it down in more detail.

The questions I have are mainly around what I’m currently receiving. For example, my therapist who I see once a week might not be able to see me anymore because a) I’m supposed to ‘buy in’ a therapist and they aren’t set up that way so it wouldn’t work with them and b) my care coordinator seems to think twice weekly therapy sessions might be a good idea but she only works part time. I honestly don’t think I can go through with building a new relationship with another therapist.

Also, I’d lose the crisis services and have to buy those in as well but who knows when they are going to hit crisis and so how can you buy that in in advance? For me, most of my problems occur out of hours – but they’ll be no access to duty so what then?

I know the aim is to reduce a&e visits and hospital stays, but is there actually anything out there at the moment that provides that kind of support 24/7?

I’m really quite scared about the process and what I’m going to end up with, but in some ways I feel a bit rail roaded into it because I’m the first one and so a lot of attention is on the case.

If anyone has any experience of their own personal payment budget purely for mental health, what have you spent yours on?

 
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