Advertisement

Community Mental Health Journal

, Volume 52, Issue 7, pp 781–792 | Cite as

Participants’ Assessment of the Impact of Behavioral Health Self-Direction on Recovery

  • Bevin CroftEmail author
  • Susan Parish
Original Paper

Abstract

Self-direction involves managing a flexible budget, selecting and purchasing services and supports to meet individual needs and preferences. An emerging practice in the behavioral health field, self-direction is part of a systemic shift toward person-centered approaches to service provision. To understand the relationship between recovery and self-direction, the authors conducted a content analysis of 30 in-depth interviews with individuals from two self-direction programs in one state. A positive relationship between self-direction and recovery was established. Meeting basic needs for food, clothing, and shelter are important first steps in the recovery process for self-directing participants. Recovery domains were dynamic and interrelated, with gains in independence, self-esteem, and self-confidence facilitating achievement of goals in other domains. To maximize the benefits of self-direction, program administrators may need to develop clearer program implementation standards and address poverty and limited access to appropriate behavioral health services and supports.

Keywords

Self-direction Self-directed care Mental health and substance use recovery Qualitative research Self-determination 

Notes

Acknowledgments

Partial support for the preparation of this manuscript was provided by an NIAAA doctoral training fellowship to the first author, Grant No. 5T32AA007567-17.

References

  1. Alakeson, V. (2008). Self-directed care for adults with serious mental illness: The barriers to progress. Psychiatric Services (Washington, DC), 59(7), 792–794. doi: 10.1176/appi.ps.59.7.792.CrossRefGoogle Scholar
  2. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11.CrossRefGoogle Scholar
  3. Berwick, D. M. (2009). What ‘patient-centered’ should mean: Confessions of an extremist. Health Affairs, 28(4), w555–w565. doi: 10.1377/hlthaff.28.4.w555.CrossRefPubMedGoogle Scholar
  4. Caplan, M. A. (2014). Financial coping strategies of mental health consumers: Managing social benefits. Community Mental Health Journal, 50(4), 409–414. doi: 10.1007/s10597-013-9674-7.CrossRefPubMedGoogle Scholar
  5. Carlson, B. L., Foster, L., Dale, S. B., & Brown, R. (2007). Effects of cash and counseling on personal care and well-being. Health Services Research, 42(1–2), 467–487.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Chamberlin, J. (1990). The ex-patient’ movement: Where we’ve been and where we’re going. The Journal of Mind and Behavior, 11(3), 323–336.Google Scholar
  7. Charmaz, K. (1983). The grounded theory method: An explication and interpretation. In R. M. Emerson (Ed.), Contemporary field research: A collection of readings (pp. 109–126). Prospect Heights, IL: Waveland Press.Google Scholar
  8. Cook, J. A., Russell, C., Grey, D. D., & Jonikas, J. A. (2008). Economic grand rounds: A self-directed care model for mental health recovery. Psychiatric Services (Washington, DC), 59(6), 600–602. doi: 10.1176/appi.ps.59.6.600.CrossRefGoogle Scholar
  9. Croft, B., & Parish, S. (2013). Care integration in the patient protection and affordable care act: Implications for behavioral health. Administration and Policy in Mental Health and Mental Health Services Research, 40(4), 258–263. doi: 10.1007/s10488-012-0405-0.CrossRefPubMedGoogle Scholar
  10. Croft, B., Simon-Rusinowitz, L., Loughlin, D., & Mahoney, K. (2013). An environmental scan of self-direction in behavioral health: Summary of major findings. Chestnut Hill, MA: Boston College National Resource Center for Participant-Directed Services.Google Scholar
  11. Doty, P., Mahoney, K. J., & Sciegaj, M. (2010). New state strategies to meet long-term care needs. Health Affairs, 29(1), 49–56. doi: 10.1377/hlthaff.2009.0521.CrossRefPubMedGoogle Scholar
  12. Doty, P., Mahoney, K., & Simon-Rusinowitz, L. (2007). Designing the cash and counseling demonstration and evaluation. Health Services Research, 42(1), 378–396.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Emerson, R. M., Fretz, R. I., & Shaw, L. L. (1995). Processing fieldnotes: Coding and memoing writing ethnographic fieldnotes. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
  14. Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy-push on patient-centered health care. Health Affairs, 29(8), 1489–1495.CrossRefPubMedGoogle Scholar
  15. Flick, U. (2007). Managing quality in qualitative research. Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
  16. Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. doi: 10.1177/1049732305276687.CrossRefPubMedGoogle Scholar
  17. Hutchings, G. P., & King, K. (2009). Ensuring U.S. health reform includes prevention and treatment of mental and substance use disorders—A framework for discussion: Core consensus principles for reform from the mental health and substance abuse community. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  18. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century (N. A Press ed.). Washington, DC: National Academy Press.Google Scholar
  19. Kessler, R. C., Heeringa, S., Lakoma, M. D., Petukhova, M., Rupp, A. E., Schoenbaum, M., et al. (2008). Individual and societal effects of mental disorders on earnings in the United States: Results from the national comorbidity survey replication. The American Journal of Psychiatry, 165(6), 703–711. doi: 10.1176/appi.ajp.2008.08010126.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. London, England: Sage.Google Scholar
  21. Mechanic, D. (2012). Seizing opportunities under the affordable care act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376–382. doi: 10.1377/hlthaff.2011.0623.CrossRefPubMedGoogle Scholar
  22. New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: Department of Health and Human Services.Google Scholar
  23. Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2013). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health. doi: 10.1007/s10488-013-0528-y.Google Scholar
  24. Pope, C., Ziebland, S., & Mays, N. (2000). Analysing qualitative data. BMJ, 320(7227), 114–116. doi: 10.1136/bmj.320.7227.114.CrossRefPubMedPubMedCentralGoogle Scholar
  25. SAMHSA. (2011). Description of a good and modern addictions and mental health service system. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  26. Sciegaj, M., Mahoney, K. J., Schwartz, A. J., Simon-Rusinowitz, L., Selkow, I., & Loughlin, D. M. (2014). An inventory of publicly funded participant-directed long-term services and supports programs in the United States. Journal of Disability Policy Studies. doi: 10.1177/1044207314555810.PubMedGoogle Scholar
  27. Shen, C., Smyer, M. A., Mahoney, K. J., Loughlin, D. M., Simon-Rusinowitz, L., & Mahoney, E. K. (2008a). Does mental illness affect consumer direction of community-based care? Lessons from the Arkansas Cash and Counseling Program. The Gerontologist, 48(1), 93–104. doi: 10.1093/geront/48.1.93.CrossRefPubMedGoogle Scholar
  28. Shen, C., Smyer, M., Mahoney, K. J., Simon-Rusinowitz, L., Shinogle, J., Norstrand, J., et al. (2008b). Consumer-directed care for beneficiaries with mental illness: Lessons from New Jersey’s Cash and Counseling Program. Psychiatric Services (Washington, DC), 59(11), 1299–1306. doi: 10.1176/appi.ps.59.11.1299.CrossRefGoogle Scholar
  29. Smith, J. A. (2007). Qualitative psychology: A practical guide to research methods. Thousand Oaks, CA: Sage.Google Scholar
  30. Spaulding-Givens, J. C., & Lacasse, J. R. (2015). Self-directed care: Participants’ service utilization and outcomes. Psychiatric Rehabilitation Journal, 38(1), 74–80. doi: 10.1037/prj0000103.CrossRefPubMedGoogle Scholar
  31. Tondora, J., & Pocklington, S. (2007). Implementation of person-centered care and planning: How philosophy can inform practice: Yale Program for Recovery and Community Health. New Haven, CT: Department of Psychiatry, Yale University School of Medicine.Google Scholar
  32. Webber, M., Treacy, S., Carr, S., Clark, M., & Parker, G. (2014). The effectiveness of personal budgets for people with mental health problems: A systematic review. Journal of Mental Health, 23(3), 146–155. doi: 10.3109/09638237.2014.910642.CrossRefPubMedGoogle Scholar
  33. Weiss, R. S. (1994). Learning from strangers: The art and method of qualitative interview studies. New York, NY: First Free Press.Google Scholar
  34. Whitley, R., & Drake, R. E. (2010). Recovery: A dimensional approach. Psychiatric Services (Washington, DC), 61(12), 1248–1250. doi: 10.1176/appi.ps.61.12.1248.CrossRefGoogle Scholar
  35. Wilton, R. D. (2003). Poverty and mental health: A qualitative study of residential care facility tenants. Community Mental Health Journal, 39(2), 139–156. doi: 10.1023/A:1022662704461.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Human Services Research InstituteCambridgeUSA
  2. 2.Lurie Institute for Disability Policy, The Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA

Personalised recommendations