Self-Directed Care: Empowering People


For over a decade, mental health advocates have been arguing for the adoption of self-directed care for individuals using Medicare and Medicaid services. Furthermore, in 2003, President Bush’s New Freedom Commission on Mental Health issued a report urging people (and their families) play a much larger role in utilizing their health care dollars.

In short, self-directed care means that participants receive the money themselves, in the form of a credit card that can be used for a variety of health care options. Working with an advisor, people are able to make their own decisions regarding managing the delivery of money that they receive for their mental health services.

Self-directed care is a centerpiece of person-centered planning, empowering participants to choose the right services that will help them in reaching their health care goals. And research is validating this movement—participants spent significantly on both traditional care (psychiatry or counseling services) and substitutes in the community, such as working out at YWCA, or a Weight Watchers program, etc. Furthermore, none of the participants in the study overspent.

A person within the program learns to budget, as well as examine and utilize a wide variety of health care options. Self-directed care ultimately gives them more responsibility than they would receive with traditional services.

“People need to get as many choices as possible, and be able to tailor the services and supports they need to recover,” says Dr. Judith Cook, Ph.D., Professor and Director at the

National Research and Training Center on Psychiatric Disability at the University of Illinois at Chicago. “I am intrigued by the idea that a person can control the money that is spent on their service delivery in a way that’s most effective for them, without costing more.”

Dr. Cook noted that everyone should have as many choices as possible when determining their health care program, and be able to tailor the services and supports they need to recover.

Studies have shown that this flexibility not only results in better health outcomes, but it also does not cost more money. “It’s interesting that consumers continued to avail themselves of traditional services, but also selected other services, things that are in line with how anyone else would reach a goal,” Dr. Cook observed. “So instead of going to a weight-loss group at their mental health center, here they can get a get a personal trainer, or join a yoga class, among a variety of options. Sometimes these are more effective, and at the same cost or less cost.”

As Dr. Cook’s article points out, self-directed care could change everything for people with mental health issues. “For people with a mental health issue, models such as this can allow them to rediscover their talents and rebuild their lives.”

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