Consumer-Directed Care/Cash and Counseling

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 5. Research on the Benefits and Costs of Mental Health Self-directed CARE

At the present time, few firm conclusions can be drawn about either the benefits or the costs of mental health SDC approaches. Research on SDC programs for persons with SMI is at an early stage of development. Only a few research and evaluation studies have been completed to date. All of these studies have substantial methodological limitations. H

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.7. Protecting Public Budgets

According to key informants consulted for this report, most states and the Federal Government will only consider implementing SDC if it will not result in increased budgetary costs for mental health care. One key informant from the managed behavioral health care industry expressed a view that may be applicable to many mental health SDC programs: t

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.6. Managing Purchases

Procedures and policies that SDC programs adopt in relation to participants' purchases may be interpreted as manifestations of programs' commitment, or lack thereof, to the principles of client self-direction and autonomy. Purchasing policies and procedures should consequently be transparent and ideally will reflect substantial input from SDC part

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.5. Ensuring that the Quality of Care is Maintained or Improved

One of the rationales for the SDC approach is that giving participants the freedom to make choices, whether good or bad, encourages personal responsibility and independence. As a result, some participants in SDC may use individual budgets to select treatment interventions that psychiatrists and psychologists would consider misguided or potentially

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.4. Ensuring Continued Receipt of Needed Care

One potential concern regarding SDC participants' greater independence in making decisions about their own care and in planning mental health spending is that some participants may choose not to receive mental health services, may dramatically reduce their spending on outpatient specialty mental health care services, or may not reserve enough mone

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.3. Protecting Participants from Coercion and Victimization

A key purpose of the SDC approach is to increase consumers' control of decisions relating to their care, and thereby increase their independence and free them from coercion in mental health treatment.

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 4.1. Ensuring that Participation is Equitable

SDC models automatically place consumers of mental health services "in the driver's seat" 2 by making them the primary decision-makers in choosing services and providers and by giving them authority over an individual budget. Although this structure supports consumers' autonomy and self-direction, it also demands greater consumer involvement in

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 i

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3.5. Contrast with Traditional Services

Mental health SDC represents both a philosophical and a practical departure from the conventional approach to planning mental health care. Key informants interviewed for this report were asked to offer their perspectives on how mental health SDC differs from traditional public mental health services (i.e., those mental health services that are typ

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3.4. Exclusions from Coverage

SDC programs generally do not include coverage for mental health visits to emergency departments or for mental health crisis, inpatient, or residential treatment services. These services also are not ones that participants self-direct or write into their recovery plans. Instead, these services are covered either by Medicaid, Medicare or private in

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3.3. Spending in Individual Budgets

The total amount of money individuals can spend in SDC is typically capped at values ranging from $1500 to $4000 per participant per year, depending on the program. 33 Some programs "cash out" outpatient mental health clinic services, which means that participants' individual budgets include the money that would have been allocated for these se

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3.2. Allowable Products and Services

SDC programs offer participants much greater flexibility in choosing products, services, and providers than is available in conventional mental health services. Budgets can be used to purchase specialty mental health care as well as many other products and services that are not offered by specialty mental health care providers. Examples of non-tra

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3.1. Program Elements

Although mental health SDC programs vary in design and staffing, most programs include the following elements (see Figure 1 ): 1 , 2

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 3. Features of Mental Health Self-directed CARE

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 2. Methodology

This report is based on a review of published and unpublished academic articles, presentations, and policy documents and on interviews with key informants. Literature and other documents were obtained by Internet search and by requesting information from experts on SDC and other consumer-directed service models. A 2007 ASPE report on the use of th

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 1.2. Objectives of this Report

Although implementation of mental health SDC programs on a larger scale may now be feasible, critical questions remain regarding how to make such an implementation successful for mental health care consumers, providers, policymakers, and public budgets. This report provides a review of available information on mental health SDC programs and presen

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 1.1. Background

Early Self-Directed Care Programs

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. 1. Introduction

Self-directed care (SDC) is an innovative program model for persons with disabilities, in which participants control an individual budget and are empowered to customize their own service plans in accordance with their preferences. 1 , 2 The SDC model is particularly well designed to promote consumer and family driven mental health care, one of

Feasibility of Expanding Self-Directed Services to People with Serious Mental Illness. Executive Summary

Self-directed care (SDC) is an innovative program model for persons with disabilities, in which participants control an individual budget and are empowered to customize their own service plans in accordance with their preferences. The SDC approach has been used extensively to serve individuals with long-term service and support needs, including th

The Contribution of Self-Direction to Improving the Quality of Mental Health Services : Table 16

From: The Contribution of Self-Direction to Improving the Quality of Mental Health Services

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