Individual Funding for People With Mental Health Issues: Opportunities, Tensions, and Outcomes

Background

Individual funding is linked to the broader personalisation agenda in disability and aged care, seeking to promote greater choice and control for people using services in a competitive market model. Individual funding has emerged in response to the shortcomings of previous block funding models where service users were tied to one provider, restricted to services the provider offered, and did not know the budget allocated for their support. From a government’s perspective, the previous model provided limited accountability for public funds, as service providers had discretion to distribute funds between running costs and participants’ supports.

Individual funding was seen as a mechanism for overcoming these limitations; giving people with disability more choice and control over services, and therefore in their lives. Disability advocates, particularly from the field of physical disability, lobbied for its introduction, as did western governments interested in potential cost savings and finding a way of meeting their obligations to give rights to people living with disability (Dickinson, 2017). Individual funding was seen as a mechanism to encourage creative planning and provide a wider range of supports to meet individual needs and preferences. People with reduced decision-making capacity would be assisted by family or professionals as appropriate. Importantly, individual funding was to place the person at the centre of the decision-making process: to choose their supports and give them greater independence and improved quality of life (Alakeson, 2008; Croft & Parish, 2016).

Individual funding programs reportedly commenced in the 1960s and 1970s when parents of children with disabilities in Canada (Hutchison, Lord, & Salisbury, 2006), and Vietnam veterans with disabilities in the US (Yeandle & Ungerson, 2007) lobbied for community living. Subsequently an array of individual funding programs has emerged in disability and aged care services, with many different structures, administrative arrangements and names. Self-directed support (SDS) has emerged as the most common name being used in Scottish legislation (2013), by the United Kingdom (UK) advocacy group In Control (2017), and by the Cash and Counseling program in the US (RWJF 2010). Under the umbrella term of self-directed support, the UK has personal budgets and direct payments (Hamilton, Tew, Szymczynska, Clewett, Manthorpe, Larsen, & Pinfold, 2016). Other terms are used elsewhere with some European countries referring to ‘cash-for-care’ (Da Roit & Le Bihan, 2010) and Australian aged care using the term ‘consumer directed care’ (CDC).