Feature Issue on Self Direction
My Voice, My Choice
Two pilot projects completed in Texas demonstrate the potential benefits of self-directed mental health care.
The first project operated from May 2009 through May 2013 in North Texas. The second, called My Voice, My Choice, ran from 2018 to 2020 in Central Texas. My Voice, My Choice evaluated the feasibility of delivering mental health self-direction through the Medicaid managed care system for adults with disabilities. Independent evaluations of both pilot projects show that people using self-direction had better recovery outcomes at no greater cost than people only using traditional mental health services. Participants reported that self-direction improved their lives by giving them the tools and support needed to reach their goals.
Self-direction for people with disabilities was originally developed in the federal Cash and Counseling demonstration. It is now available to people who are enrolled in Medicaid-funded home and community-based services programs in all 50 states. While most of these programs focus on people with physical or developmental disabilities and older people, some states, including Texas, are exploring self-direction for people diagnosed with a serious mental illness.
Key Concepts in Mental Health Self-Direction
Mental health self-direction is based on several key concepts:
- A person-centered plan is developed by the person to reach the goals they define for themselves.
- An individual budget is used to obtain goods and services to meet personal goals as defined by the person’s plan. This can include traditional services like counseling and nontraditional items such as job training and gym memberships.
- Advisers are trained professionals who provide support, mentorship, and advocacy to help people develop plans, create budgets, and make purchases.
Importance of Recovery
Recovery is key to mental health self-direction. There is no “cure” for mental illness, but there is a process of positive change that involves improving health and wellness, living a self-directed life, and striving to reach one’s full potential.
Recovery outcomes can include improved mental well-being, increased confidence, hope, and self-esteem, better community participation, and improved engagement in mental health services. Over time, these outcomes can lead to reduced inpatient care and more consistent use of community mental health services. Participants in My Voice, My Choice worked with trained recovery advisers to create plans tailored to their goals. Participants managed the individual budgets to purchase goods and services used to help implement their recovery goals. The participants’ Medicaid managed care plans funded the self-directed budgets, using a portion of the regular per-person, per-month payments they received from the state.
A state university with experience in implementing person-centered services hired, trained, and supervised the advisers. Some participants bought bus passes or bicycles so they could attend social and community events. Others used their budgets to achieve life goals like getting a general education degree. Mental health self-direction encouraged participants to take ownership of their mental health care, make decisions aligned with their goals, and regularly update their plans with their recovery advisor and chosen supporters.
Future of Mental Health Self-Direction in Texas
The Texas pilot projects highlight the value of giving people more control over their services. Self-directed care enables people to work toward personal goals that motivate them and promote recovery.
The Texas Health and Human Services Commission (HHSC) is exploring options for a mental health self-direction program. To develop recommendations for potential implementation, HHSC is seeking advice from people and organizations with an interest in self-direction, including people with lived experience of serious mental illness.
Learn More
To learn more about mental health self-directed care in Texas, visit Mental Health Self-Directed Care on the Texas Health and Human Services Commission website.
Case Study: Planning, A Budget, and Success
A 23-year-old woman lived with her parents in Central Texas, but dreamed of independence.
Her challenges – significant mental illness, an intellectual disability, hoarding, and difficulty organizing her daily life – made this dream seem unattainable. She had supportive parents and received mental health counseling and job coaching, but she felt she needed to take a different approach.
The young woman took the leap and enrolled in the My Voice, My Choice pilot. With guidance from her adviser, she developed a plan and budget to achieve her goals: building life skills, managing anxiety, and gaining confidence to live independently. She used her individual budget to buy home organization items, purchase a swimsuit to attend swim classes, and eventually bought a sofa for her first apartment. Over two years, she made significant progress, managing her finances, decluttering her space, and becoming more involved in her community.
Four years after the project ended, she continues to live independently, participate in Special Olympics events, and manage her responsibilities. She credits the program for her improved self-confidence and independence.