Care Programme Approach

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 practiced 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