Self-direction is rooted in principles of recovery, independence, self-sufficiency, and choice. It recognizes that all people can determine and achieve their goals. Self-direction also holds that every person has basic human needs for fulfillment, as well as unique interests and preferences for living a meaningful life.
What is Self-Direction?
In self-direction, people with serious mental health conditions enrolled in publicly funded programs control a monthly budget, and, in some states, purchase goods and services to help them reach their goals for recovery and independence. People in self-direction can be creative, as long as their purchases directly support the goals they identified in the life plans they develop for themselves. For example, they may choose to put some of their funds toward continuing their education, securing stable housing, or joining a gym.
People who self-direct say it is inspiring. And evidence from the United States and abroad shows that self-direction in mental health works—and at a cost similar to or lower than that of traditional service programs. It does not necessarily require a large amount of money. A little bit can go a long way—but flexibility in how to use funds is important.
What's It Based on?
Self-direction is based on the concept “nothing about us without us,” which holds that people must be empowered to steer the direction of their own lives and services. This concept also holds that people with lived experience must be consulted at all levels of decision-making—from service planning and delivery to policy and oversight.
The self-direction model first took root as a way to help people with physical and intellectual and developmental disabilities live more independently. Many states have experience with it in this regard, but self-direction in mental health service delivery is relatively newer.
Self-direction approaches generally share the following basic elements:
Each person develops a life plan, drawing on their strengths, capabilities, and potential, along with assets available in the community. The plan includes concrete goals reflecting the person's priorities for quality of life and independence. These goals may address issues related to health and well-being, social connectedness, education, employment, and other priorities.
The life plan integrates supports for everyday needs like housing, employment, and physical and behavioral health services with self-directed funding to achieve the goals outlined in the plan.
Individual budgets typically are determined based on the value of publicly funded services the person otherwise would have received. Participants have an array of options for spending their funds on goods and services that support their independence, in accordance with their life plans; these options vary depending on the state. By controlling their budgets, participants do not lose access to medications or emergency services.
Sometimes called recovery coaches or life coaches, support brokers work closely with program participants to develop, implement, monitor, and adapt their life plans as their circumstances change. Some programs employ peers—people with lived experience of mental health recovery who have received training in mutual support—as support brokers.
These peer support brokers frequently forge powerful relationships with participants, who, perhaps for the first time, have someone in their lives who both understands where they are coming from and respects and encourages their independence.
MONITORING AND QUALITY MANAGEMENT
Every state has mechanisms for regularly monitoring service use and expenditures. Participants can change services as needed within the constraints of their budgets, in consultation with their support brokers. Misuse of funds has been rare.
For a point of comparison and for program planning purposes, states can examine encounter claims data for Medicaid beneficiaries who use outpatient mental health services. Texas, for example, has used this type of data-based approach to establish expenditure levels.
Financial Management services
Program participants have access to financial managers who can help with responsibilities such as writing checks, preparing tax returns, and tracking budgets.