Mental health service users have yet to reap the benefits of greater choice, control and independent living, which direct payments have facilitated in other groups of community care users, particularly people with physical disabilities. To redress this imbalance a national pilot to promote direct payments to people with mental health needs in five local authority sites across England was set up and evaluated. The evaluation used a multi-method approach incorporating both qualitative and quantitative data, including individual semi-structured interviews and group discussions with key stakeholders across the pilot sites. This article draws on findings from the pilot evaluation to provide a preliminary understanding of how applicable the independent living philosophy is to mental health and what opportunities direct payments offer for service users. When given the opportunity, service users were able to use direct payments creatively to meet a range of needs in ways which increased their choice, control and independence. This suggests that the benefits of greater independent living through direct payments may be realisable in mental health. However, a number of ways in which the principles of direct payments in mental health could be 'downgraded' were identified. The evaluation results indicate that a thorough understanding of the independent living philosophy needs to be developed in the context of mental health.

Background: Increasing demands for the greater take-up of direct payments necessitates the willingness and ability of care co-ordinators to be able to meet this challenge. Aim: To consider how workers have responded to direct payments in practice and how they can enable or limit greater access. Method: The analysis presented here is primarily based on 20 in-depth interviews with care coordinators who took part in an evaluation of a national pilot to implement direct payments in mental health. Results: Three key responses were identified which mediated care co-ordinators' pursuit of direct payments as an option for clients: using selective criteria; incorporating it into a dominant framework (of 'providing services') and re-conceptualizing their role as enabling greater capacity for choice and control. In order to make sense of these responses it was necessary to examine their conflicting work context. Conclusions: Initiatives such as direct payments suggest the need to re-appraise the role of care coordinators and may require a significant shift in the focus of their practice. Whilst tensions inherent in their role may make this shift difficult, the analysis also suggests that it could lead to opportunities for putting into practice ideas about user empowerment which should be central to their practice. Declaration of Interest: None.

In the context of public concern about homicides committed by mentally ill people, the assessment and Risk assessment and the Care

No abstract