New Publication Promotes Self-Directed Mental Health Care

May 20, 2008—Self-directed care puts mental health consumers in control of their own recovery, according to a publication from the Bazelon Center for Mental Health Law. Aptly titled In the Driver’s Seat, the guide explains a new approach to the delivery of community services to people with psychiatric disorders and offers strategies and tactics for consumer advocates to promote its use in public mental health systems.

The premise of self-directed care, according to the authors, is the “understanding that people with mental illnesses should be free to make choices about important aspects of their lives.” This concept is implemented through the consumer’s choice of providers and mental health services and control of a budget to spend for whatever will help attain the goals identified in his or her recovery plan. Although it does not include psychiatric services or hospitalization, the budget can be used to meet a range of needs—for example, education, dental care or start-up costs for a micro-business. Such control “will increase the likelihood that consumers will feel satisfied and benefit from the care provided.”

The approach has been successful in public systems serving older people and those with intellectual disabilities. It is now being piloted for mental health consumers in several states. In the Driver’s Seat takes an in-depth look at the planning for and operation of self-directed mental health care, with examples from pilot programs in Florida, Oregon and Michigan.

One of three appended fact sheets discusses various financing approaches, pointing out that “it should not increase public systems’ costs…to allow consumers to choose providers and select the types of services they will receive based on the existing array of services.” Still, self-directed care initiatives “are not free.” In addition to funding consumers’ budgets for nontraditional services, supports and purchases, the projects “must also hire brokers to assist consumers with planning and training.” States have financed these costs in the pilot programs primarily through state appropriations and with flexible federal funds and Medicaid.

The 38-page guide was developed by the Bazelon Center and the UPENN Collaborative on Community Integration. Its authors are Bazelon Center policy director Chris Koyanagi and policy analyst Elaine Alfano. In the Driver’s Seat is available online as an Adobe PDF at http://www.bazelon.org/issues/mentalhealth/publications/DriversSeat.htm. Print versions may be purchased through a link to the Center’s online bookstore or by sending $7.50 plus $4 postage and handling to the Publications Desk at the Bazelon Center, 1101 15th Street NW, #1212, Washington DC 20005; pubs@bazelon.org; 202-467-5730 ext 141.

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The Bazelon Center for Mental Health Law is the leading national legal-advocacy organization representing people with mental disabilities. It promotes laws and policies that enable people with psychiatric or developmental disabilities to exercise their life choices and access the resources they need to participate fully in their communities.