The Care Programme Approach was officially adopted into the national mental health care framework in 1991, and later adapted and revised. The cornerstone of the CPA is the Care Plan, a documented plan of the needs and strengths of a service user, and how to manage these in the future. The Care Plan also identifies all the people involved in that service user’s care, and any risk factors. For people who are in contact with multiple professionals (for example a therapist, a neurologist, a psychiatrist etc.) a care coordinator is named. This person assumes overall responsibility for the Care Plan and for coordinating the different professionals. Care Plans are also dynamic, and should be reviewed regularly with the service user (usually something like every six months).
As defined in the Department of Health literature Making the Care Programme Approach Work For You, the CPA is supposed to be a collaborative effort with the service user. In fact a large driving force behind the adoption of this model was the complaints of the service users that they felt they were being treated like objects, that they had no say in the care they were receiving and their opinions were completely unvalued. In the Central and North West area there is a target that 30% of care plans should be written in the first person – that is, by the service user.
“It is also expected that all people providing services do so within a set of personal / professional values that:
-Shows respect for you as a person including recognition of your personal strengths and qualities
-Respect your dignity at all times
-Offer you information about reasonable choices you can make regarding your care and support.
-Demonstrate respect for equality of opportunities for all, regardless of ethnic origin, gender, sexual orientation, culture, or spiritual beliefs.
-Help you feel as in control of the whole process as possible
-Respect the views of people who are important to you”
As the importance of carers and families has been more recognised, it has also become a recognised practice to involve the support network around the service user in the care plan, and to invite them to the care plan review meetings.
As well as recognising the problems and needs of the individual, Department of Health guidelines state that the care plans should also look at the strengths of the service user and how these can be developed / leveraged to promote recovery and wellbeing. Finally, the service user should always be provided with a copy of their care plan as soon as possible after it has been completed.
It drives me potty to hear about badly produced care plans. I have heard of care co-ordinators copy/pasting care plans across different clients (!), leaving entire sections of the plan blank, writing no risk factors, or (and this is REALLY common) writing only the barest of plans. By this I mean one sentence responses in sections, showing that the person filling out the care plan has not really paid any attention to the service user. To say something like “service user fine” in a care plan review is simply not acceptable.
So, psychology students, medical students, and anyone else who might one day find yourselves completing someone’s Care Plan: Remember what it is you are filling out, and what its purpose is.
