Self-Directed Care
Self-directed care (SDC) is an innovative practice that emphasizes that people with mental health and substance use conditions should have decision-making authority over the services they receive.
Individuals are encouraged to take direct responsibility to manage their care, including determining their own needs, deciding how those needs are met, and continuously evaluating the services.
In SDC programs and initiatives, individuals control a budget that supports them in working toward their recovery and wellness goals. These financial resources can be used for things like transportation, gym memberships, employment-related goods and services, and traditional mental health services.
The mental health care system is not exempt from systemic racism and discrimination practices - there are many barriers to care for BIPOC, like lack of insurance, language and communication differences, and lack of diversity among providers (in 2015, approximately 86% of psychologists in the U.S. were white).
The way people talk about and experience mental health is uniquely shaped by their racial/ethnic backgrounds and cultural experiences. Because SDC gives the individual seeking services the power to decide what works best for them, it allows people from marginalized communities to determine their own priorities in recovery and move beyond traditional systems of care, which weren’t originally designed with them in mind. SDC creates space in treatment plans for culturally relevant services and goes beyond diagnosis to treat the whole person.
SDC grants individuals autonomy, agency, and choice. It gives people seeking services the freedom to decide what is meaningful and life-enhancing to them. These factors are crucial in empowering individuals to take control over their own care, wellness, and life - and when people are motivated, they are more likely to succeed in recovery.
The Western medical model of mental health care focuses on concrete diagnoses and a handful of treatment options for each diagnosis. Services within this model, like therapy and medication management, are powerful tools for many individuals. But many others, especially those with marginalized identities, don’t find these services effective or accessible.
SDC can be integrated into any established system of care - it is not a separate system in itself, but a philosophy that allows the individual receiving services to choose which supports work best for them. This may include some aspects of the Western medical model but remains flexible for the utilization of alternative services that meet the individual’s unique needs.
There are a number of benefits to SDC programs, including:
- Increased self-determination for participants.
- Greater use of, and higher participant satisfaction with, services and care.
- Outcomes such as employment and housing stability, self-sufficiency, and engagement in mutual support and self-advocacy, all of which contribute to sustainable mental health recovery.
- Greater participant ability to ask for help, rely on social support from others, and willingness to pursue recovery goals over an extended period of time.
Everyone’s experience with a mental health condition is different - which means everyone’s treatment needs are different, too. Those with mental health challenges are experts in their own experiences and needs and should be empowered to create their own individualized wellness plan.
While SDC programs are often based on providing help-seeking individuals with funding to manage as they see fit, the general philosophy of SDC is something that anyone can integrate into their wellness plan.
- Know what will - and will not - work for you. Understand what supports and services match your lifestyle and expectations – if a treatment option requires you to change too much too quickly, it is unlikely to stick. The most effective services are ones that fit into your current life and are sustainable in the long term.
- Focus on shared decision-making (SDM). SDM notes that there are two experts in a provider-patient relationship - you are the expert on yourself and your life, and the provider is the expert on mental health conditions and how to treat them. Start with educating your provider about your concerns and goals. Then learn from them about your diagnosis and treatment options and do not hesitate to ask questions. Work as a team to come to an agreement about what next steps are best for you.
- Be ready to advocate for yourself. You know yourself better than anyone else does, regardless of credentials. It is important to speak up if a provider suggests something that won’t work for you or doesn’t seem to understand your individual needs. If they are not receptive to your input, it is okay to seek out new treatment options or providers.