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

机译：向心理健康状况不佳的服务使用者提供直接付款的障碍和困境

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摘要

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.
机译：2003年，英国工党政府强制地方当局向所有符合条件的人提供直接付款，并将继续积极推广这种服务选择。本文探讨了为什么与其他用户组相比，接受心理健康服务用户直接付款的速度特别慢的一些关键原因。本文的主题来自于2000年至2006年间发表的大量文献和研究的详细综述，将为从业人员和学生提供有关精神卫生服务直接支付当前主要实施问题的概述。导致摄取率低的几个主要障碍和困境包括立法本身以及地方当局的指导。本文讨论了关于精神卫生服务使用者资格的书面混淆，以及在卫生和社会护理双重服务提供的背景下，需求波动造成的不利影响。除了恢复的基本过程外，还讨论了不同的残疾模型。考虑到从业者和护理协调员不愿向精神卫生服务使用者提供此项服务的证据，特别是他们对权力的渴望和对冒险的厌恶。本文的结论是，精神卫生团队中的许多社会工作者需要重新评估他们目前的态度和做法，以使直接支付成为可行和有吸引力的服务选择。

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