Blackburn with Darwen Personal Health Budget (PHB) Pilot was funded by Lancashire and South Cumbria Integrated Care Board. Mental ill-health is the largest single source of burden of disease in the UK. Almost 23% of the total burden of disease in the UK is attributable to mental disorders, compared to 16.2% for cardiovascular disease and 15.9% for cancer. 1 in 4 families worldwide is likely to have at least one member experiencing mental ill health or behavioural difficulties. People in marginalised groups are at greater risk of mental health problems, including people from Black, Asian and other minority ethnic (BAME) backgrounds, lesbian, gay, bisexual and transgender people, disabled people and people who have had contact with the criminal justice system, among others. Barriers to accessing mental health support and the role of cultural beliefs and attitudes have been cited as explanations for existing mental health inequalities that face BAME communities living in the UK.

Black and ethnic minority communities, especially Black and South Asian groups experience more adverse pathways to care, higher rates of compulsory admission and treatment, more contact with the police and criminal justice agencies and poorer longer-term outcomes compared with White British people.

“Good mental health is recognised as an integral part of a person’s wellbeing, embedded in all aspects of their whole life, their beliefs, faith, culture, environment, spirituality, work, housing, education, family and community respect. Extract from Race Equalities Foundation, Mental Health and Wellbeing Briefing Paper – Race Equality Foundation

In 2020/21 The Race Equality Foundation partnered with National Health Service England to look at how PHB’s could assist in helping improve access to Mental Health support. The project evaluation showed numerous positive outcomes and suggested areas for further development which led to the development of the Blackburn with Darwen PHB pilot.

The purpose of the small-scale Pilot Personal Health Budget programme in Blackburn with Darwen was to work with the identified target audience (Asian women and young Asian men) with unmet mild to moderate mental health needs who were known to or working with partners but reluctant to engage with Mental Health services.

Having an in-depth person-centred conversation with people to identify what may work for them to improve their mental health and how, with control over a small amount of money through accessing a personal health budget may help them achieve this.  The average PHB awarded was £ 456, which funded items such as laptop, clothing, gym membership, a bed, decorating a lounge, TV and a short break away.

The pilot worked with 13 people, 7 of whom were recruited by Healthy Living. Participants completed both an initial and follow up Short Warick Edinburgh Mental Well Being Score to capture whether the personal health budget had made any difference to their wellbeing. All 7 people showed an improvement in this when comparing both initial and final scores.

“I feel more hopeful for myself. I feel like I can do something now, I’ve got another purpose aside from being a mum and wife”.

“I can also use the laptop for my own things like job searches on Indeed, updating my CV and doing other online courses. The option to do other online courses is there now whereas before I wouldn’t even have tried or considered it before; it’s opened up other opportunities”.

“I’d like to say thanks, you’ve made my life easier. I was really worried about my qualification but now I’m able to continue and am closer to getting a good job”.

“The short break refreshed my mind, I don’t feel stressed at home, it’s not even a thing, I’m just enjoying time for me and the kids. I came back home and could focus on doing me – I organised swimming lessons, chased up the hospice about some complementary therapy and joined they gym with my sister. Thank you so much for this opportunity, I’d give you a big hug, I feel like a different person. There’s only one word for it…AMAZING”.

“I can’t thank you and charities enough for all the support. Having a bed has made me feel like a human again. It’s so nice to go to my room and just relax”.

“Exercising has given me more strength, not just in my body but inner strength too. I feel strong making my own decisions and sticking to them. I feel mentally stronger, focussing on myself is easier and I feel more in control of my emotions”.

“I feel a lot more in control with the way things are going, thank you so much”.

Case Study

W fled domestic violence and was homeless and pregnant for a while; the system designed to help her out of the situation made it worse for her, “it made me feel like I was failing at everything, the stress was too much”. She now lives in a social housing property with her young son in Blackburn, her son is the most important person in W’s life and is the driving force for her to improve her emotional wellbeing “I want him to grow up feeling loved and respected. I don’t want him to know how bad I feel or that he spent his first few months in a refuge”. She has had a lot of therapy and was feeling ‘therapied out’ but has recently joined a women’s group which she feels is giving her the support she needs now. They’ve supported her to start learning to drive which she feels will make her much more independent and confident. W also volunteers “I use my experiences of the system for escaping domestic violence to help make services better for other women, I’m an expert by experience. It helps me to know my suffering can help and protect someone else”.

W continues to struggle with anxiety and lacks confidence which affects all area of her life. Her house is somewhere she needs to feel relaxed and safe, she painted the walls and bought carpets when she moved in, however due to the initial cost everything was the cheapest she could find and everyday life, especially with a young child, has left the property looking tired with surface level damage, “There are scuffs on the walls from getting the pram and now bikes and scooters in and out of the house, the white squares on the lino have turned yellow and the carpet has come away from the walls and ripples up in the room. I’ve tried to repair things, but I end up making it worse. I don’t know how to fill the cracks around the doors and windows and stop them coming back, I painted one door and it’s patchy and looks awful. I often wake with night terrors, I need to take myself out of the bedroom, I make myself chai and sit in the living room to relax but all I can focus on is the stains on the walls and the rippling carpet, I think to myself ‘I can’t do this, I can’t fix it’.”

“I want to feel like I’m living not just surviving like I am now, the last few years I haven’t had the chance to live. I want to walk into my home and feel relaxed, that it’s beautiful and clean. I feel like a house is a healing place but my house with all its tears, stains and missing things needs healing before I can heal in it. I want to start making it feel like a home not a shelter for survival. I want to create a place of calm where I can invite people over. I’m meeting new people through the group I go to but I can’t invite them over – I don’t want to explain why to them that I’m ashamed of my house. I don’t want them to know about my past. I think that changing the decoration will make me feel like life has changed and that I’m moving forwards.”

“I’m learning about gardening so I can make the garden nice eventually, I’ve made a corner that has lavender plants and eventually I’ll get a swing or chair for me to chill in.”

We spent a lot of time discussing all options that would help W improve her mental health and wellbeing, looking at the skills she had from all the counselling she has had and the things she’s doing well at now, such as taking a more leading role in the groups she attends and organising days out for the women and their children. Eventually W decided that improving the appearance of her home would have the biggest and most immediate effect and would have far reaching benefits. Having a route from her front door into her living room that looks inviting would enable her to invite women from the group over allowing her to develop closer friendships, feeling relaxed at home would improve her ability to manage her anxiety and seeing something changing and getting better would help her realise that things are moving forwards and getting better. With this in mind, we asked for a personal health budget to paint the hall and living room, replace the lino in the hall and kitchen and re-carpet in the living room. W valued being able to choose whatever colour paint she wanted and get her dream flooring “I’d really like the carpet that you can see the lines when you hoover, having the criss-cross wood effect lino would be amazing. I can’t have white walls, they’re too empty but the yellow colour that they are now is too dark for such a small space that only has one small window. Pale grey feels like a relaxing light colour. When I got the carpet before I didn’t have a choice, I had to get whatever was the absolute cheapest, anything that would cover the concrete and sharp bits for my son who was learning to crawl. Having a choice feels great”. We were able to employ a female decorator which was really important to W, she also explained the decorating process to W, from preparation to finishing touches, so that she had the knowledge to be able to continue decorating the rest of the house in her own time. We helped her dispose of the old carpet at the local tip, somewhere W had never been before. While she lacked confidence making decisions for herself initially we were able to support and empower her chose all aspects of the work, working within the budget given, which improved her confidence enough to go out and buy new door handles herself. She also had some shelves built into an alcove in the hall which allowed her to store kitchen items rather than having them piled on the worktop “I used to avoid going into my kitchen, even doing the dishes, because I didn’t want to be in the room, I felt embarrassed if anyone saw it, but the new lino has made such a difference, I love going and cooking there, it feels clean and inviting, I even allowed a friend in while I made chai for us”. The improvements downstairs empowered W to continue upstairs, sorting through her son’s old clothes and toys, cleaning as she went.

“I would like to express my heartfelt appreciation to all those who played a pivotal role in transforming my house into a beautiful and safe haven for both me and my child. As someone who battles anxiety, I often find myself grappling with episodes of nightmarish proportions, making it incredibly challenging to step out of my room and venture into the hallway. In fact, merely descending the stairs used to intensify my feelings of sadness and insecurity, each mark on the way acting as a painful reminder of my perceived flaws.

However, with your invaluable assistance, I was able to rewrite this narrative. Undoubtedly, the process of renovating my home brought about its own set of trials and tribulations, occasionally triggering my anxiety. Nevertheless, the end result served as a poignant reminder of how wonderful life can be when we muster the courage to seek help. I vividly recall a day when I was grappling with one of my episodes, engulfed in a profound sense of despair. Yet, as I made my way downstairs, I reminded myself that the newly renovated hallway was a testament to the possibility of a brighter future. It became a symbol of hope, dispelling the darkness that had shrouded my life for so long. Today, every time I step into my home, my spirits no longer plummet as they once did. Instead, I feel as though my living space has undergone a healing transformation, and I am entering a new world where happiness prevails and flaws are replaced by tidiness and brightness.
The decision to let go of the old flooring forced me to reflect on the notion that I need not settle for something that does not align with my true self.

I want to extend my deepest gratitude to each and every one of you for granting me a space that truly belongs to me. This space not only inspires me but also reminds me of the endless possibilities that life has to offer. Your kindness and support have created a haven of hope and positivity within the confines of my home, and for that, I am eternally thankful.”