Nigel Turner's HyperGUIDE to the Mental Health Act

Care Programme Approach [CPA]

Background

The Care Programme Approach [CPA] has been called the cornerstone of the Government's mental health policy. It was introduced in 1991 and is intended to be the basis for the care of people with mental health needs outside hospital. It applies to all people with serious mental health problems who are accepted as clients of specialist mental health services.

In many cases, the CPA comes into play while someone is a psychiatric hospital in-patient (not necessarily detained under the Mental Health Act), and creates the framework for discharge planning and aftercare. The CPA framework can be used in relation to aftercare which has to be provided in accordance with Section 117 of the Mental Health Act, but the statutory health and social services agencies need specifically to ensure that their Section 117 duties are being fulfilled within any CPA care plan agreed. The CPA also links in with Care Management practised by local authority social services departments, where social services departments are undertaking their duties of assessing needs and purchasing appropriate services, under the NHS and Community Care Act.

If the relevant bodies are co-operating, and have consistent procedures, then the CPA, Care Management and (where applicable) Section 117 duties, can all often be integrated into a single process.

Four Stages of the CPA

The CPA process has four stages:

1. A systematic assessment of the person's healthcare and social care needs
2. The development of a care plan agreed by all involved, including the person her/himself and any informal carers, as far as this is possible, and addressing the assessed needs
3. Identifying a key worker, to be the main point of contact with the person concerned and to monitor the delivery of the care plan
4. Regular review of the person's progress and the care plan, with agreed changes to the plan as appropriate.

   Four Levels of the CPA

   Not everyone who is client of specialist psychiatric services will require an equally full or complex CPA approach. In practice, four levels of the CPA exist:

   1. Minimal CPA, which is appropriate for people who:
      
      • have few healthcare needs
      • need low levels of social support
      • are likely to remain stable.
      Often the person concerned will only be in touch with the key worker, and the care plan will simply define the expected nature and frequency of contact with that key worker, and set a review date.
      
      
   2. More Complex CPA, for people who:
      
      • need a medium level of support
      • may need further continuing assessment
      • are less likely to remain stable.
      In these cases, the person is likely to receive support from more than one professional discipline, and the care plan will be more complex.
      
      
   3. Full, multi-disciplinary CPA, for people who:
      
      • have a severe mental illness
      • are not functioning well socially
      • may represent some risk to themselves or others
      • may be unstable and volatile.
      The care plan is likely to be very detailed, with arrangements for continuing monitoring , and special attention is required to communication between the various professionals involved.
      
      
   4. Supervision Register. Where a person represents a significant risk to themselves or others, they may be placed on the Supervision Register. This is a form of at risk register, which aims to ensure that someone at risk is actively followed-up, and to reduce the chances that such a person will slip through the community care net.

   Key Features

   The CPA exists to ensure that several, perhaps obvious, principles of good practice are realised. These features include:
   

   • a multi-disciplinary approach to community care provision, following psychiatric admission
   • systematic planning, recording and reviewing of the person's care and support
   • a universal top level system, which integrates other requirements such as Section 117 aftercare, Care Management and the Supervision Register
   • the involvement of users and carers in the creation and review of the care plan
   • indentifying a lead person [key worker] to take responsibility for overseeing the delivery of the care plan
   • flexibility of service provision, responding to the person's changing needs
   • ensuring a proactive approach is taken to offering support, in an attempt to ensure that people do not lose touch with services which they have been assessed as needing
   • a swift and appropriate response if a person's mental health deteriorates.

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   Overview page. Contents page. Introduction page.

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   Copyright © Nigel Turner 1996
   
   This page last revised 3 November 1996
   While every effort has been made to ensure the accuracy and reliability of information in these pages, they are not intended to be relied upon as an authoritative statement of the law. The author cannot accept liability for errors or omissions.