Why relationships go hand in hand with personalisation

17 May 2016

By Andy Warren, Director of Operations and Development, Together for Mental Wellbeing

Nowadays in mental health, we are used to placing a lot of emphasis on the individual – and rightly so. This is a must when we’re learning what someone wants and needs, what their aspirations are, what kind of support works for them, and so on.

Personalisation is, after all, about people shaping the support they receive and being in control as they work towards becoming more independent. It is about recognising that each individual is the expert in what works best for them.

But for all this attention paid to the individual before us, no one exists in isolation (and if they do, this is unlikely to promote good wellbeing). Those of us supporting people with their mental health can’t afford to disregard the relationships an individual has with family, carers, friends, support agencies, health professionals and peer supporters. These relationships all impact on someone’s wellbeing, recovery and their chances of eventually living independently.

Reinforcing networks of relationships

In fact, relationships actually often matter more as a person becomes increasingly independent and starts needing less formal support. Imagine someone in a residential service – let’s call him Gavin – is preparing to gain enough independence to get his own flat and live without formal support.

Gavin has been supported to cook healthy meals and really enjoys this, but he knows he’s much more likely to make the effort to cook when he’s feeding more than one person, so having a friend round improves his diet.

Gavin has a phobia of hospitals, and so relies on having a friend to accompany him to appointments. He also knows he starts to isolate himself when his mental health is deteriorating, but often doesn’t recognise this himself. His support worker knows how to spot this early enough to warn Gavin but someone else will need to fulfil this role once he’s in his own flat.

Gavin loves badminton and has been playing regularly with someone else from the service, which really helps to keep him fit. He’ll need to make an effort to maintain this friendship to keep this hobby up in future. 

When you are working alongside someone towards a goal of living independently in their community, part of the preparatory work is about piecing together and reinforcing this network of relationships that will support them in their new life. If leaving a service feels like a leap into the unknown, your chances of success are bound to be slim.

Some relationships don't work

We have to recognise too that certain relationships sometimes simply aren’t going to work. It might be that a person’s mental health problem is rooted in negative family relationships. They may not want any kind of relationship with one or more family members, and this is an entirely legitimate choice.

For someone else, constructing positive relationships with mental health professionals might never have been possible. It isn’t constructive to see this as a situation that will have to change for them to improve their wellbeing. They may find it much easier to form a strong constructive bond with a peer supporter, for example. 

A service has a duty to keep its relationships healthy too. And I’m not talking only about relationships between staff and service users, their carers and families. How a service engages and interacts with referrers, the local community, the commissioner and partner organisations will all have an impact on its ability to support people successfully.

Just as with personal relationships, it’s important to make sure these relationships are resilient so they can survive and continue to be beneficial when things are difficult.

Delivering personalised support

So, to go back to personalisation, delivering truly personalised support and delivering it well is about much more than direct payments and tracking goals. The nature of the relationship someone forms with the person they are supporting is a deciding factor in whether that support is personalised or not.

By the same token, someone could judge that they have a very good relationship with their support worker but this doesn’t mean that worker is necessarily putting them in control or supporting them towards increased independence. When support is genuinely personalised, the person supporting never sees themselves as the answer to someone’s problems, and is always planning for the moment when that person will no longer need them.

It’s a real skill to build this literally self-effacing attitude to supporting someone. 

This week we are launching the results of an independent evaluation of our personalised accommodation-based support. When, as part of the evaluation, we needed to build a picture of service users’ engagement in health-promoting lifestyle activities, we knew that alongside factors such as diet, exercise and sleep, we needed to include questions about the quality of relationships.

This meant asking people about things like how they settle arguments, whether they give other people praise, and how easy they find it to show love and warmth. We also made sure we asked about relationships with professionals, so for example whether someone would ask a doctor to clarify or explain information, and whether they would report a symptom to a health professional. 

Relationships also featured regularly as a theme in the personal goals people set for themselves, and in their comments about the support they were receiving.

Overall, the evaluation uncovered three main outcomes of using the service: people’s wellbeing increased significantly, they started leading healthier lifestyles, and they moved on to live independently in the community. I have no doubt that relationships played a decisive role in all three. 

Read the results of the Mental Health Foundation’s independent three-year evaluation of Together’s Progression Together services.