This section includes a number of frequently asked questions about enablement (as a model of care), and about our Enablement Programme and what it means for service users and staff.
What is Enablement?
Enablement is a strengths-based model of care, founded on the principles of self-help and independence, focusing on keeping patients well and preventing the need for higher level care whenever possible. The aim is to enable patients to identify and work towards their own community, social and employment goals.
Why is the Trust doing this?
The Trust is striving towards a more 'enabled' way of thinking and working because:
- It will allow for better (and more sustainable) outcomes for patients
- It is an opportunity to empower and develop our workforce
- It is what patients want – from our service and for their live
How does it fit with recovery?
It is derived from the same principles as recovery. However, recovery has become associated in recent years with services for people with severe and enduring mental illnesses. Enablement is intended to apply the same principles to all of our services, including community services, and a new word is needed.
Isn’t it a bit of a vague term?
It is intentionally a broad, umbrella term intended to include a number of more specific models of working used in parts of our services, or in social care, such as recovery, co-production and re-ablement, among others. We need a term which has not already been tightly defined by others, so it is inevitably open to a charge of vagueness, to which the only answer is specific examples for specific services.
What is ‘Live, Love and Do’ about? Isn’t it a simplistic way of describing what we do?
The phrase ‘live, love and do’ is intended to remind us that, ultimately, most service-users give high-priority to a safe and secure home ('Live'), friends and relationships ('Love'), and inclusion in society through meaningful activities ('Do'). This is what we want to achieve for service users through the enablement programme.
Is it evidence based?
Given that it is an umbrella term, enablement cannot be described as an evidence based approach. As far as we know no organisation has implemented an equivalent model of care across a whole system, let alone evaluated it, though other areas are certainly trying. However, there is evidence for some of the models of care we wish to introduce as part of the wider enablement approach, such as recovery. But it is also important to note that service models are complex interventions set in complex systems and it is not usually possible to obtain epidemiological evidence (such as randomised controlled trials) for such interventions - which doesn’t mean we shouldn’t try to innovate and measure improvement as best we can.
Is it about saving money?
The enablement programme wasn't established to save money. Given that the idea behind enablement is to empower patients to live a healthier, more independent life - which may mean relying less on secondary services - it is expected that the programme will indirectly reduce costs to secondary mental health services.
Does it just mean discharging people to primary care?
The Clinical Strategy has stated for some time now that a significant proportion of long-term service users could be supported in primary care. However, in practice, this is difficult to achieve with the current model of service. Primary care is rightly concerned that it cannot simply substitute for the care provided in secondary care. Rather than expecting primary care to offer long-term monitoring and support for service users with long-term disabilities, enablement is about giving our service users the tools to make use of their own strengths (where possible) to help manage their condition, and to encourage them to access a wide range of services in the community (such as education, supported employment, or benefits and housing advice). While less people will be managed long term in secondary care, specialist services need to be responsive to changing levels of need so that GPs and service users know they can come back when required.
Is it about deflecting patients on to other services?
Enablement is not about 'deflecting' patients around to other services, nor is simply about discharging. It is about recognising when there is a dependence on services (when, perhaps, is not entirely necessary), and enabling service-users to live the best, most independent life they can.
Enablement can potentially transform the entire mental health system by shifting the boundaries in provision of service between primary and secondary care, health and social care, and the voluntary sector. This, of course, will not happen without the support of all organisations connected to mental health services, which is why this Programme places great emphasis on building on – and working in – partnerships across the community wherever possible.