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Care Planning Works
The Care Programme Approach in mental health has been around since 1990. Since then it has been the major framework for delivery of care for people with mental health problems. It has been reviewed and revised to focus on those with more severe and complex problems. It has been criticised for patchy implementation, it has survived changes of government, changes of policy, and is still with us. And there is some evidence that it is working!
The Care Programme Approach (or CPA for short) is not greatly different to any other form of care planning . It is a systematic approach to delivering care to people with severe mental health problems, involving an assessment of health and social care needs, an agreed care plan, allocation of a care co-ordinator (usually a mental health professional) who is responsible for ensuring the care plan is carried out, and regular review of the plan. The CPA has always had a tiered approach and since 2008 only applies to those with the severest problems, though its principles should apply to anyone receiving care and support for their mental health problems.
A research study published earlier this year by the Mental Health Foundation based on interviews with service users found a lot of evidence of good practice under the framework of the CPA. One of the key elements of this was not just how good the professionals were, but how good their relationships with service users were. The Government’s review into the CPA made similar conclusions ‘The quality of the relationship between service user and the care co-ordinator is one of the most important determinants of success’.
A study undertaken amongst others, by former government Mental Health Tsar, Professor Louis Appleby, found fewer incidences of suicide by people who had been discharged from in-patient services where the person was subject to the Care Programme Approach.
The inquiry into the care and treatment of MN reported in 2006, made a detailed analysis of the Care Programme Approach. The inquiry said that if MN had received properly co-ordinated care under the CPA, it would have afforded so many opportunities for his diagnosis and treatment to be properly reviewed, and could have allowed for much helpful input and information from his mother and other family members.
Some workers feel that the CPA is overly bureaucratic, and yes it does involve compiling of plans, and organising meetings, but the structure is there to support good practice and good relationships, not get in their way.
Service users’ experiences of recovery under the 2008 Care Programme Approach Dorothy Gould Mental Health Foundation 2012
Refocusing the Care Programme Approach Policy and Positive Practice Guidance Dept of Health March 2008
Independent Inquiry into the Care and Treatment of MN Avon Gloucestershire and Wiltshire Strategic Health Authority June 2006
Suicide in recently discharged psychiatric patients: a case-control study National Conﬁdential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester 2009