Obstacles and Dilemmas in the Delivery of Direct Payments to Service Users with Poor Mental Health.

In 2003 the English labour government placed a mandatory responsibility on local authorities to offer direct payments to all eligible people and are continuing to actively promote this service option. This paper explores some of the key reasons why the take-up of direct payments for mental health service users has been particularly slow compared to other user groups. The main themes of this article have been drawn from a large, detailed review of literature and research published between 2000 and 2006 and will provide practitioners and students with an overview of the key current implementation issues concerning direct payments in mental health services. Several major obstacles and dilemmas have contributed to low uptake including the legislation itself as well as local authority guidance. This paper discusses the documented confusion surrounding eligibility for mental health service users as well as the detrimental impact of fluctuating needs set in the context of a dual service provision of health and social care. Differing models of disability are discussed in addition to the fundamental process of recovery. The evidenced reluctance of practitioners and care co-ordinators to offer this service provision to mental health service users is considered, particularly their desire for power and aversion to risk taking. This paper concludes many social workers in mental health teams need to reappraise their current attitudes and practices to enable direct payments to become a viable and attractive service option. [ABSTRACT FROM AUTHOR]