Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4. Critical Issues in the Design of Mental Health Self-directed CARE


SDC offers increased autonomy and flexibility in choosing services and providers for persons with mental health disabilities. If mental health SDC is implemented on a large-scale, mental health systems as a whole could benefit from a re-orientation of services towards a focus on recovery. However, SDC also needs checks and balances to ensure the integrity and sustainability of mental health SDC programs. Safeguards may be needed especially to ensure that SDC programs:

  • Conduct outreach and establish enrollment procedures that support participation by a broad range of consumers who may want to consider SDC.

  • Provide adequate education about SDC and decision-making supports to participants, some of whom may have decisional impairments and variable service needs.

  • Provide adequate education about SDC to clinicians and other related clinical and administrative staff.

  • Provide adequate staff training and administrative support, which may require additional information systems and other administrative infrastructure.

  • Have adequate infrastructure, administrative capacities, and procedures to respond rapidly and flexibly to changes in SDC participant status resulting from mental health crises, changes in physical health, or changing life circumstances.

  • Protect participants from coercion or exploitation and protect them from harm during acute psychiatric episodes.

  • Ensure that the quality of mental health care is maintained or improved.

  • Establish reasonable standards around approvable purchases.

  • Monitor participants' spending and maintain programs' total costs (i.e., variable plus fixed costs) at acceptable levels.

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