Care Programme Approach

Care Programme Approach (CPA) in the United Kingdom is a system of delivering community mental health services to individuals diagnosed with a mental illness. It was introduced in England in 1991[1] and by 1996 become a key component of the mental health system in England.[2] The approach requires that health and social services assess need, provided a written care plan, allocate a care coordinator, and then regularly review the plan with key stakeholders,[3] in keeping with the National Health Service and Community Care Act 1990.

History and impact

In 1999 the approach was simplified to standard and enhanced levels, the term key worker was changed to care coordinator, and there was an emphasis on risk management, employment and leisure, and the needs of the carer.[4]

There is some criticism that the approach has changed the role of staff away from implementing clinical interventions into administrative tasks,[5][6] that the policy is carried out inconsistently,[7][8][9] and has not been well aligned to clinical models of case management.[10] Formal review on the impact and effectiveness of this initiative has been difficult because of the variation of clinical interventions given under a CPA model.[11]

CPA in a prison setting

A research paper by M. Georgiou and J. Jethwa discusses the purpose of the CPA model and discusses key themes in its benefits and shortcomings, in order to provide a more organized framework for care of inmates in a prison setting. The key themes are listed below.[12]

Objectives of CPA
  • Interagency collaboration
  • Catering to the complex needs of the patient
  • Ongoing care (upon release from prison)
  • Patient involvement in CPA, centered around them

Challenges faced when implementing CPA
  • Responsibilities are not clear
  • Geographically deprived for program outreach
  • Patient has little or no awareness of CPA
  • Lack of understanding CPA process
  • Prison capacity to implement program (e.g., too many cases, not enough resources, patient dropout from CPA)

See also

References
  1. Department of Health (1990). "Care Programme Approach" Circular HC(90)23/LASSL(90)11. London: Department of Health
  2. Department of Health (1995). Building bridges. A guide to arrangements for interagency working for the care and protection of seriously mentally ill people. London: HMSO.
  3. "CPA association". Archived from the original on 8 May 2009. Retrieved 29 June 2009.
  4. Department of Health (1999). "Effective care co-ordination in mental health services: modernising the care programme approach". London: Department of Health. Retrieved 29 June 2009.
  5. Simpson A (December 2005). "Community psychiatric nurses and the care coordinator role: squeezed to provide 'limited nursing'" (PDF). Journal of Advanced Nursing. 52 (6): 689–99. doi:10.1111/j.1365-2648.2005.03636.x. PMID 16313382.
  6. Easton, C.; Oyebode, F. (1996). "Administrative demands of care programme approach". BMJ. 312 (7045): 1540. doi:10.1136/bmj.312.7045.1540a. PMC 2351243. PMID 8646162.
  7. Bindman J, Beck A, Glover G, et al. (October 1999). "Evaluating mental health policy in England. Care Programme Approach and supervision registers". The British Journal of Psychiatry. 175 (4): 327–30. doi:10.1192/bjp.175.4.327. PMID 10789298. S2CID 25896815.
  8. Schneider J, Carpenter J, Brandon T (November 1999). "Operation and organisation of services for people with severe mental illness in the UK. A survey of the Care Programme Approach". The British Journal of Psychiatry. 175 (5): 422–5. doi:10.1192/bjp.175.5.422. PMID 10789272. S2CID 21845991.
  9. Venables D, Hughes J, Stewart K, Challis D (2005). "Variations in". Care Management Journals. 6 (3): 131–8. doi:10.1891/cmaj.6.3.131. PMID 16642687. S2CID 23000567.
  10. Simpson A, Miller C, Bowers L (August 2003). "Case management models and the care programme approach: how to make the CPA effective and credible" (PDF). Journal of Psychiatric and Mental Health Nursing. 10 (4): 472–83. doi:10.1046/j.1365-2850.2003.00640.x. PMID 12887640.
  11. Burns T (May 1997). "Case management, care management and care programming". British Journal of Psychiatry. 170 (5): 393–5. doi:10.1192/bjp.170.5.393. PMID 9307684.
  12. Georgiou, Megan; Jethwa, Jemini (1 January 2021). "Planning effective mental healthcare in prisons: Findings from a national consultation on the Care Programme Approach in prisons". Journal of Forensic and Legal Medicine. 77: 102105. doi:10.1016/j.jflm.2020.102105. ISSN 1752-928X. PMID 33370674. S2CID 229714642.
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