Consumer direction refers to a process whereby consumers control the spending of public resources on their behalf. It is a practice that began in the physical and intellectual disability arena when individuals with disabilities (and their families when children are involved or in cases where individuals are incapacitated) were given control over hiring, firing and directing personal assistants. Programs such as Cash and Counseling (funded by the Robert Wood Johnson foundation) and Independence Plus (a Medicaid program) launched the concept.
While the focus is still heavily on control of personal assistants, consumer direction has been broadened, particularly in the mental health field. Some individuals in public mental health systems are given real choices over services and supports provided to them and may even have full control of a small budget, although the latter is still quite uncommon. Supports to enable the person to handle their resources, as well as broad guidance for the use of funds, are typically provided in consumer-directed programs.
The Bazelon Center strongly endorses giving consumers choices about services and who delivers those services, in addition to providing small but flexible budgets that allow individuals to purchase services, supports, and items/goods that help facilitate recovery.
We also support inclusion of consumer-directed options for people with mental illness in state Medicaid plans and have urged the federal Centers for Medicare and Medicaid Services to promote these practices.