Mental Health Information : Care Programme Approach (CPA)

What is it?

Care Programme Approach (CPA) is a system that was set up to ensure that people with mental illness have the support and treatment that they need from services. Care Programme Approach requires that Adult Care Services arrange and co-ordinate the care and medical treatment that a person requires.

When a person is referred to the Community Mental Health Team, an assessment of their needs will take place. This can sometimes result in a person being directed to other services, but where a person has mental health needs that they need more support with, the person will be allocated a Care Co-ordinator from the Mental Health Team. As mentioned in an earlier section, a Care Co-ordinator is usually a Social Worker or Community Psychiatric Nurse who is based at the Community Mental Health Centre. Your Care Co-ordinator will be the person that you work most closely with in terms of planning your support and the person that you can contact to discuss issues and concerns. Once a Care Co-ordinator is allocated, a care plan will be devised. This care plan is part of the CPA process. All individuals who are in hospital or receiving services in the community from the Mental Health Team will be part of the Care Programme Approach.

What is a Care Plan?

Everyone who is part of the CPA process is entitled to a care plan. This care plan is developed with you and takes into account your health needs and your social needs. For instance, it may contain information about medication and about support needed with housing, activities, claiming benefits etc. It should contain details of the services that are going to support you and identify which service will work with you on each area. This care plan will be reviewed regularly, so that as your needs change, the care plan can be adjusted accordingly.

The care plan should also contain information about what to do and who to contact in a crisis.

The CPA record/ care plan will also contain a risk assessment. This is a record of any risks that are associated with working with you. This can feel daunting and uneasy for some people and can be a difficult area to discuss. Usually, this will contain information about any known risks that are apparent to the professionals who are working with you. It generally covers areas such as risk to self, risk to public, risk to family, risk to children and risk of exploitation. For instance, someone who has had suicidal thoughts, or who has attempted suicide would come under the category of risk to themselves.

The risk assessments are also reviewed regularly and if you are unhappy with what is recorded on your risk assessment, you can discuss the reasons for this with your Care Co-ordinator.

What are the CPA levels?

There are two levels of CPA. You will be allocated to a CPA level depending on your level of need for support/treatment. The CPA levels reflect the extent of your mental health needs and the range of input you need from different services. Each person's needs are unique and are assessed as such, but the following contains some general guidelines.

Standard CPA
  • You require support from one agency, or only minimal support from more than one agency
  • You are able to manage your own mental health difficulties on the whole
  • You have a good support system through family, friends, etc
  • You do not present any or few risks to yourself or others
  • You are actively seeking support from services

If you are on Standard CPA, then your care plan will most likely be reviewed between you and your Care Co-ordinator

Enhanced CPA
  • You have more complex needs, which require support from various agencies that need to work together, in order to support you effectively.
  • You may need intensive support from the agencies that are working with you.
  • You may be more likely to have other difficulties as well as your mental health difficulties. For example, you may also have drug/ alcohol difficulties.
  • You may be more likely to present risks to yourself or others when you are experiencing mental health difficulties.
  • You may find it difficult to keep in contact with services and require a more planned and sensitive approach to your needs

Your CPA level may change over time as your needs are reviewed.

What are CPA Reviews?

If you are on Enhanced CPA, there will be regular reviews where you and the professionals who are supporting with you will discuss the care plan and make any necessary changes to its content. These review meetings are organised as necessary and usually take place at the Community Mental Health Centre, but the venue can be in other places such as a hospital ward, GP surgery, even at home on some occasions. They are often attended by the Psychiatrist who is responsible for your medical treatment. This meeting is to ensure that you and those who are working with you are happy with the care plan and feel that it is relevant to you. These review meetings form part of the Care Programme Approach. Your Care Co-ordinator will be responsible for co-ordinating services and making any necessary referrals to other agencies, if new needs are identified.

If you want support with these reviews, you can invite a family member, carer, friend, Mind representative or advocate to attend them with you. (For information about advocacy, please follow the link.

How long will I be on CPA for?

This would be discussed and reviewed at the CPA review process. You will not normally be discharged from the CPA process unless you no longer have a need for support/ treatment from the mental health services. If you are not receiving services, then you would also be discharged from CPA. Clearly, the long term aim is for this to happen when possible. However, for some people who have serious mental illness, they may need ongoing support and treatment through the CPA process to maintain their mental health.

If you are discharged from the mental health service, but feel that you need support again at a future date, then you can contact your GP and ask to be referred back to the Community Mental Health Team.