The Care Programme Approach: time for frank talking

Tom Burns,Judy Leibowitz

doi:10.1192/pb.21.7.426

Abstract

The Care Programme Approach (CPA) was introduced as a cornerstone of the Government's mental health policy in 1992 (Kingdon, 1994). It was meant to clarify the complex issues surrounding the coordination of care for the severely mentally ill and to promote interprofessional communication and effective targeting of resources by community mental health teams (CMHTs). The Ritchie report into the care of Christopher Clunis (Ritchie, 1994) underlined the need for clarity about who has overall responsibility for coordination and review of the progress of care – the key worker. The report makes a compelling case for a clearly documented care plan with identified problems, therapeutic goals and an unambiguous statement of who is responsible for what and when. How, then, could this virtuous proposal generate conflict and bad feeling? And why is there relatively little debate about it in the professional press?

Highlights

TduhceedCaraes PraogcraomrnmerestonAepprooafchthe(CPGAo)vweransmeinnttr'os mental health policy in 1992 (Kingdon, 1994)
Marshall (1995) links the CPA to the development of care manage ment and case management, and insists that as government policy it cannot be properly subject to evaluation
Case management is brought into the confusion along with care management and the Care PLraongcreatm. m"CeareAmpparnoaagcehm. enAt: reacednistasetrdoituosriaml isitnakteh"e

Summary

Tom Burns and Judy Leibowitz

TduhceedCaraes PraogcraomrnmerestonAepprooafchthe(CPGAo)vweransmeinnttr'os mental health policy in 1992 (Kingdon, 1994). Rigorous evaluation confirmed clinical impres sions that this approach was expensive and unhelpful (Curtis et ai 1992; Franklin et al 1994) It is this model of brokerage caadsoeptemdanabgyemeBnrtitishwhicshociaalppesaerrsvicteos haavse b'ceaerne management' in the wake of the Griffiths report (Griffiths, 1988). Clinical case management evolved from the discredited brokerage model In this approach the case manager is a health or social services professional responsible for much of the direct care for the patient. Since there has been a growing convergence of case manage ment models to emphasise small case loads targeting specific clinical groups, and stressing assertive community-based work This approach has been extensively researched in the US (Solomon, 1992: Burns & Santos, 1995), and repeatedly demonstrated to benefit patients, often with cost savings. On the down side it has many part-time members, only one full-time community psychia tric nurse (CPN), and the in-patient services are four miles away in a forbidding Victorian mental hospital building

The Care Programme Approach

Conclusions