Money Matters: Participants’ Purchasing Experiences in a Budget Authority Model of Self-Directed Care

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Self-directed care (SDC) is a service delivery model in which individuals diagnosed with a severe and persistent mental illness (SPMI) direct their behavioral healthcare by managing an individual budget and purchasing the goods and services they deem most helpful in meeting their needs and supporting their recovery. Participants may purchase conventional mental health services as well as alternative goods (e.g., books, clothing) and services (e.g., fitness classes) to support their recovery. Several quantitative studies have examined the types of purchases commonly made by SDC participants. This qualitative study builds on this research by reporting findings from interviews with 18 SDC participants on the factors that influence their purchasing decisions, the benefits derived from SDC purchases, and perceived barriers experienced in making desired purchases. Findings reveal the extent to which money matters in mental health recovery and suggest that individualized budgeting and purchasing contribute to SDC participants’ mental wellness and stability, enhance their control over service choices, and, most notably, provide some material relief in ongoing struggles with chronic poverty. Findings also highlight the importance of flexible spending guidelines and streamlined approval processes; overly proscriptive policies may undermine participants’ self-determination. Additional implications for SDC practice, policy, and research are discussed.


Published in Social Work in Mental Health