Care Programme Approach
The Care Programme Approach (CPA) was introduced by the Department of Health in 1991 to provide a framework for effective mental health care. It makes sure that people with mental health difficulties receive the care and support they need in a care package tailored to them as an individual.
On the following pages you will find information to help you understand how mental health care is assessed, delivered and reviewed by the Trust and local authorities within the CPA.
If you receive mental health services from the Trust you will receive care either under the Care Programme Approach (CPA) or under Standard Care.
- What is CPA?
- What is Standard Care?
- Who is my care coordinator?
- What is a care and support plan?
- How can I be involved in making my care and support plan?
- Who can read my care and support plan?
- What rights do I have under CPA?
What is CPA?
CPA stands for the ‘Care Programme Approach’ and is for people with mental health problems who have complex needs. Your CPA describes how your care will be assessed, planned and delivered to provide you with the extra to support your need to overcome the difficulties you are facing.
What are complex needs?
Having a mental illness can make it difficult to cope with everyday situations, such as:
- Physical health
- Self-harming/ harm to others
- Financial difficulties
- Alcohol/ drug misuse
- Memory problems
- Mental Health Act requirements
- Ethnicity/ culture
- Living with a learning disability
- Involvement with mental health services and accessing support
These are complex needs and if your mental illness makes it difficult to cope with any of them, CPA is used to give you the extra support you need to manage them.
What is Standard Care?
If you receive care from the Trust for a mental health illness but you do not have complex needs, i.e. your illness does not make it difficult for you to cope with the above situations, you will receive your care under Standard Care. This means your care package will only include the support that you do need to cope with situations.
What happens on CPA or Standard Care?
Whether you are on CPA or Standard Care, you will have:
- An assessment of your health and social care needs
- A copy of your written care and support plan or statement of care
- Reviews of your care at least every year
- The option to have a carers assessment for your carer
- A named care coordinator who will keep in touch with you
- The offer of a personalised budget for your social care needs, subject to eligibility.
If you are eligible for support under CPA or Standard Care you will also be eligible for support under a local authority policy called Fair Access to Care Services (FACS).
Who is my care coordinator?
Your care coordinator is usually a nurse, social worker, occupational therapist, psychologist or psychiatrist. It is their job to make sure your care and support plan is carried out and they will work with you to ensure they have a good understanding of you and your needs.
Care coordinators are trained in delivering mental health services and have the authority to access the services you need as agreed in your care and support plan. They may not be the mental health services worker with whom you have the most contact when you are using Trust services, but they will know what support you are receiving.
Your care coordinator will:
- Make sure your cultural and language needs, disability needs and needs for advocacy are met
- Show respect for you as a person and treat you with dignity
- Look at all your needs and offer you information about choices you can make about your care and support, to promote your control over your care
- Keep in touch with you and make sure you are involved in planning your care
- Liaise with your family, with your permission, and other professionals who give you support
- Make sure you understand your care and support plan and who is involved in your care
- Discuss other ways of meeting your social care needs through personalised budgets
Wherever possible you will be involved in the process of identifying who your care coordinator will be.
What is a care and support plan?
Your care and support plan describes the services and support you need and identifies whose responsibility it is to provide them. A care and support plan can also be used as a support tool.
Your care and support plan is a written record of the actions and plans agreed with your care coordinator. It also recognises your strengths, skills, hopes and aspirations as well as ways of coping.
Your care and support plan will include details about your:
- Mental health
- Physical health
- Social circumstances i.e. housing, employment, friends, family etc
- Contingency plan and crisis plan
Your care and support plan will also include information on risks. This means risks that affect you, and/ or ways in which you may pose a risk to other people. Your care and support plan will look at the least restrictive ways to reduce these risks.
Your care and support plan will also include what to do when things are not going well and who to contact in this situation. It will also inform you of what will happen if you choose not to keep appointments etc. These can be referred to as contingency and crisis plans.
You will be offered a copy of your care and support plan to keep and asked to sign it. Your care coordinator will also sign it. This is to show that you agree to the care arrangements detailed in the plan.
Care and support plans will be regularly reviewed at meetings with all those who are involved in providing your care. You can also attend these review meetings but you do not have to. Every effort will be made to ensure that the meetings are carried out in the least stressful and most supportive way and that they take place at a time and place convenient to you.
You have the right to:
- Be told in advance where and when the review meeting will be
- Have a friend and/or advocate attend with you, or on your behalf
- Request a review meeting yourself – you can ask for a review at any time if there has been a change in your circumstances.
A review meeting will take place at least once every twelve months.
If you are receiving your care under ‘Standard Care’ your care and support plan may be offered to you in the format of a letter, which is also given to your GP. This can also be referred to as a clinicians’ letter or statement of care.
How can I be involved in making my care and support plan?
The relationship between you and your care coordinator will work best when it is a partnership. This is important and will help you and your carers, if you wish, to be given the opportunity to be involved in all stages of the CPA.
If you choose not to be involved, your care and support plan will be written for you and you will be sent a copy.
Your family, friends, carers and advocate can be involved in care and support planning meetings if you wish. Even if you request that they are not, carers have a right to know certain details of the plan, i.e. when your care and support plan directly affects them. Your carer may also find it useful to have a clear plan that includes who they will be able to contact if there is a crisis.
Advanced decision/ statement
Some people like to write down exactly how they want to be treated if they face difficulties in the future. This is called an advanced decision/ statement.
An advance statement sets out your feelings, beliefs and wishes for future care.
An advance decision sets out treatments that you would want to refuse.
Both the advance decisions and statements are written when you are well and can be included as part of your CPA/ Standard Care.
Who can read my care and support plan?
All information about your care, including your care and support plan, is managed by the Trust in accordance with the Data Protection Act 1998 as well as local health and social care guidelines on confidentiality.
You can find further information about what happens to your information in the leaflet ‘Confidentiality of your information’, which you can get a copy of by contacting customer services on 0800 587 2108 or view the leaflet online.
All health and social care professionals directly involved in your care have access to the information on your care and support plan. CPA forms will also usually be sent to your main carer if you agree and to your GP.
You have the right to disagree with this and this decision will normally be upheld.
There may be occasions when a worker may feel that some information is very important and should be shared with other relevant people. This will happen particularly where there are issues of risk or when there is a clear need for other professionals to be made aware of the information. Other CPA information, like your needs assessment, may also be shared with mental health services.
Other agencies may need to see assessments before they can decide whether to offer someone a place within their service. You should be made aware that this information is being shared and may, in any case, be involved in completing the forms.
If you have any concerns about the sharing of your information having read the ‘Confidentiality of your information’ leaflet, you can discuss this with your care coordinator. Information will not be shared without your knowledge and consent, except in exceptional circumstances.
What rights do I have under CPA?
You have the right to:
- Have someone suitably skilled and experienced to coordinate your care.
- Be fully involved in all aspects of your care and to have a copy of your care and support plan or statement of care.
- Bring an advocate and/ or friend and/ or carer to support you through the process, participating in all meetings and reviews.
- Have access to your healthcare records including any assessment and care and support planning documentation.
- Request another opinion on any aspect of your care.
- Complain if you are dissatisfied with any aspect of your care.
- Access information about your diagnosis and medication.
- Refuse your consent to proposed sharing of information, although this may limit your treatment options.
- Have your information protected in accordance with the Data Protection Act 1998.
What rights does my carer have under CPA?
Your care co-ordinator should be aware of who your main carers are and the important role that they play. Your carers also have a right to receive support and information from mental health services.
However, this right must be balanced with your right to confidentiality as the service user.
If your carer provides substantial and regular support for you, they can be supported in the following ways:
- Have an assessment of their care needs, reviewed ( as a minimum ) once a year
- Have their own, carers written care and support plan outlining the support to be provided to them
- Be involved in the development of your care and support plan and attend review meetings if you agree to it. Your consent will be obtained usually before the information is passed to your carer
- Advised who to contact in a crisis and what the contingency plan is ( The contingency plan is aimed at preventing a crisis situation from developing and a crisis plan outlines what will happen if a situation turns into an actual crisis )
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