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Outside the planning system
The Care Programme Approach (CPA) in mental health has had a chequered history. It was introduced in 1990 as a means of planning and delivering care for people with mental health problems. Implementation in the early years was patchy and was often the focus of inquiry reports – why wasn’t it happening everywhere? A review in 1999 emphasised the importance of how mental health care should be based on the CPA. A further review in 2008 tried to rationalise how it operated. The view was perhaps because the structure of meetings and documentation was too heavy, perhaps the way forward was to say CPA should be limited to those in severest need, and everyone else in receipt of mental health care should get that care in accordance with CPA principles – that is a plan of care, without calling it the CPA. That’s a quick history of the CPA – and it probably sounds confusing.
Inside or out?
Professionals and service users and their families are often left wondering “What happens to my care if I’m left outside the CPA?” Government guidance says ‘It is important that service users and their carers are reassured that when the support provided by CPA is no longer needed that this will not remove their entitlement to receive any services for which they continue to be eligible and need, either from the NHS, local council, or other services.’ (Refocusing the Care Programme Approach Dept. of Health 2008). The idea of withdrawing the CPA for some people does fit in with the recovery model. If those in severe need have had a large input of services, hopefully they can achieve a level of recovery that means they need less intense services, and it may mean that overall monitoring of their mental health care can be with their GP, or perhaps just a psychiatrist. This means you don’t have to be on CPA for ever, nor does it mean (and this does worry service users) that you should not be entitled to a range of other services. Nor should it mean you can’t get access in the future to the intense range of services offered by a Community Mental Health team.
Sticking to principles
Whether you’re on the CPA, or not, the principles of care in mental health should be the same. Those principles are that any plan of care should be based on an assessment of your needs, you should be involved with drawing up that plan, and you should get a written copy of that care plan. To quote the Government’s guidance again: ‘The CPA is an approach that should continue all the time.’