Looking at Self-Directed Services for People with Serious Mental Illness or Substance-Use Issues

Conducting an environmental scan of self-direction in adult behavioral health services and supports

    • November 18, 2013

Dates of Project: September 2011 to March 2013

The National Resource Center for Participant-Directed Services conducted an environmental scan of the behavioral health field to determine interest in a self-direction model of care for individuals with serious mental illness or substance-use issues.

Description: Previous studies of cash and counseling programs—in which participants choose the services and supports that best suit their needs—have focused on people with physical and cognitive disabilities and not on people with serious mental illness including those with co-occurring substance-use issues.

The center’s report—An Environmental Scan of Self-Direction in Behavioral Health: Summary of Major Findings—states that:

  • The introduction of self-direction programs in behavioral health services will require a paradigm shift from a medical model to a more holistic recovery model, and a culture change, involving a shift in the balance of power from mental health providers to their clients.
  • More than 60 percent of program directors in behavioral health surveyed indicated they are "very interested" in implementing a self-direction program in their agency.
  • Program directors also indicated that support from “champions” in local and state government and grassroots and peer-advocacy groups would encourage the implementation of self-direction programs.
  • They perceived challenges to the implementation of self-direction programs, including uncertainties in federal health regulations, such as implementation of the Affordable Care Act and regulations governing self-determination programs for Medicaid recipients.

Based on the findings, the project team recommended a randomized controlled trial of the self-direction model in behavior health and proposed a design for such a study as well as potential funding sources.

“[Self-direction] is great; I have nothing but good feelings about it. It’s so important to me, that if the government is going to cut spending, I don’t want them to cut this, because it’s needed. It’s a lifesaver—literally,”—A Participant in a Self-Directed Program.