What is the Care Programme Approach?

The Care Programme Approach (CPA) was introduced in 1991 and is the framework through which Health and Social services provide mental health care in the UK. It applies in all Hospitals and Community Mental Health Teams (CMHT). CPA defines four essential components of good practice that anybody seen by specialist mental health services has a right to expect.

	a thorough assessment of their health and social care needs
	a written plan detailing the care they are to receive
	a care coordinator assigned to them to see that the agreed plan is delivered successfully
	regular reviews of the plan and where necessary agreed changes to it

Levels of CPA

CPA is also the system used by Mental Health Services to prioritise people with the worst problems and ensure that they receive the higher level of care they need. It does this by dividing those who receive Mental Health Services into two groups.

Standard CPA - Anybody seen by Specialist Mental Health services is automatically entitled to the standard level of CPA and the four components above. People cared for on standard CPA will typically require the support of only one mental health professional or agency, and pose no danger to themselves or to others. They will not be considered to be at high risk if they lose contact with services.

Enhanced CPA - is for individuals with multiple care needs, who need to be in contact with more than one professional or agency. This group will need more intensive help from a range of services and may include those who have more than one clinical condition and/or a drug or alcohol problem. This group would also include those who are hard to engage and/or with whom it is difficult to maintain contact. Some people on enhanced CPA could pose a risk if they lost contact with services. Mental Health Services prioritise resources towards this group.

Careplans

Everybody receiving Mental Health Services should have a Careplan clearly showing the health and social care being provided and include:

	The names and contact details of all the key people involved with the service users care
	Details of medication and possible side effects
	Details of planned contacts with Mental Health Services

The Careplan for someone subject to enhanced CPA should also include

- Information about accommodation, domestic support as well as employment, education or training.
- A crisis plan that sets down action to be taken when a service user's mental health is deteriorating rapidly. This may include, for example, strategies that have worked effectively in the past and details of a person who the service user responds well to in times of crisis.
- Contingency arrangements for the service user in the event that either the care co-ordinator is unavailable or that part of the care plan cannot be carried out at short notice. This could include, for example, details of alternative service providers who would be willing to provide interim support

The Role of the Care Co-ordinator

The "Care Co-ordinator is the person who has lead responsibility for ensuring that your Care Plan is delivered successfully. This can be any professionally qualified member of the CMHT, and is likely to be the person with whom you have most contact. As the name implies that person is then responsible for co-ordinating the care you receive make sure that everybody involved is pulling in the same direction on your behalf. Your Care Co-ordinator is also responsible for making sure that you have a Care Plan entered on the electronic CPA system (see below) clearly showing what service(s) you are being offered; and that you have a copy.

Electronic Care Plans

Since April 2002, Community Mental Health Services in Hereford have been using an electronic system to produce, store and share Care Plans, now agreed as the standard format for CarePlans. The eCPA system uses a secure network of computers, accessible only to those involved in your care. This includes CMHT staff, staff at the Stonebow Unit, your GP, and some on-call doctors and social workers who might need to see you in an emergency out of normal working hours. The aim is to make sure that any professional you see about your mental health has instant access to up to date information about the care you are receiving and any other relevant information about you. Although the system is not a complete electronic version of your mental health records, by making your Care Plan available wherever you are seen, it should make running over the same old ground with every new member of staff you see, a thing of the past.

The electronic Care Plans include the following components:

• Demographic details (name, address etc).

• Assessment of your mental and physical health.

• Assessment of risks you may face at as a result of mental ill health.

• Actions, agreed with yourself, to be taken by professional carers as a result of these assesments.

• A Crisis Plan that includes your preferences as to what should happen to you in the event a deterioration in your mental health.

• A Carers Plan designed to identify and deliver support needed by anybody involved in looking after you at home.

• Other information about your home situation and any support you may need there.

• Information about your employment status, or education or training needs.

Want to know more ?

For more information about electronic CPA records contact:
Simon Hamilton
Mental Health Project Manager
Herefordshire Health Informatics
Tel: 01432 262032
Tel (m): 07816 536968
email:simon.hamilton@hhtr.nhs.uk