Care Programme Approach (England)

The Care Programme Approach (CPA) is for people in England with severe or complex mental health problems and those who may need services from a number of agencies to support them.

The CPA guidance says that if you are currently or have recently been sectioned under the Mental Health Act, then you should be supported under the CPA.

The CPA guidance says you should have:

• support from a CPA care coordinator
• a full assessment of your needs, taking account of all the services who will be giving you support
• a written care plan, which includes plans for risks you may face and what should happen if you are in crisis
• ongoing review of your care, including a full review of all the support you are receiving from all services at least once a year
• consideration of ongoing need for CPA support
• consideration of your need for support from an advocate
• support for your carers. This means your carers should be identified, and told of any rights they may have to have their needs assessed. This is to find out if your carer needs help to give you care.

The range of issues which your care planning will cover will depend on your condition and your exact needs. It will often include considering:

• what medical treatment you need both for your mental and physical health, including medication
• what risks there are to your own wellbeing and safety and to the safety of others
• what support should be provided to you if you find yourself in crisis
• any needs you may have as a result of problems with alcohol or drugs
• your personal circumstances including family and carers
• your financial circumstances
• your housing needs
• your employment, education and training needs

The CPA guidance is clear that the assessment and planning of your care should aim to meet your particular needs and should not just focus on what services can be offered.

Any discharge plans should be agreed with you and should involve your family and carer if this is what you want. The care plan should also not simply focus on your difficulties and needs but also on your strengths and what you hope to achieve with the support of services.

As soon as you are admitted to hospital, the people responsible for your healthcare should start assessing your needs and planning your discharge. This is stated in the English Mental Health Act Code of Practice and guidance from the National Institute for Health and Care Excellence (NICE).

Before you leave hospital, there will be a discharge meeting where people involved in your care will develop a discharge care plan for you addressing your needs.

The care plan should:

• be discussed, planned and agreed with you
• support effective working between the various people who will be involved in your care after you are discharged (such as your social worker, your Community Mental Health Team and your GP)
• include assessments of risks you may face and plans for how to deal with problems you may have after your discharge and give you information about how to contact people who can help you. NICE guidance says that if you are considered to be at risk of suicide, arrangements should be made to follow-up with you within 48 hours of you leaving hospital.

You should be given at least 48 hours’ notice of the date for your discharge from hospital and your care arrangement should be discussed with any family or carers who will be involved in your care.

Care and Treatment Plan (Wales)

A Care and Treatment Plan (CTP) is a written plan in Welsh or English covering what you want to achieve in certain areas of your life and what mental health services will help to do this.

You have a legal right to a CTP if you receive secondary health services in Wales. Secondary health services might be care you receive from a psychiatrist, a community psychiatric nurse, a social worker or a member of the Community Mental Health Team.

Your CTP will cover eight areas:

• finance and money
• accommodation
• personal care and physical wellbeing
• education and training
• work and occupation
• parenting or caring relationships
• social, cultural or spiritual
• medical and other forms of treatment including psychological interventions

The CTP will have a section setting out the outcomes you want to achieve in these areas. At least one of these outcomes has to be set out, but generally your care planning should try to cover outcomes you want to achieve in more than one of those areas.

The CTP will also have a section which sets out:

• the services which will be provided to you to help you achieve those outcomes
• the date when those services will be provided
• who is responsible for providing them

Your care coordinator will be responsible for working with you, other people involved in your healthcare and your family and carer (if you want to involve them) to agree to the outcomes in the CTP.

When you access secondary services, your local health board or local authority should appoint a care coordinator as soon as reasonably practicable. This might be:

• a psychiatrist
• a psychiatric nurse
• a social worker, or
• another healthcare professional

If you already have a CTP before you are detained in hospital, it will be reviewed within 72 hours of your admission and updated. If you do not have a CTP before you are detained, a care coordinator will be appointed and a CTP will be prepared.

• Assessment and planning. While you are in hospital, the people responsible for your healthcare should start assessing your needs and planning your discharge.

• Care services. The local health board of the hospital you are in and the local authority where you usually live should take steps to identify in good time before your discharge appropriate care services to support you when you leave hospital.

• Consultation. They should consult you, your family and carer (if that is what you wish), your care coordinator and other healthcare professionals involved in your care.

• If hospital managers or a Mental Health Tribunal are considering your discharge, they will expect your healthcare professionals to provide information about what care arrangements have been made for you if you are discharged.

• Discharge meeting. Before you leave hospital, there will be a discharge meeting where people involved in your care will develop a discharge care plan for you addressing your needs. You (with support from your family and/or IMHA if you wish), your care coordinator and other professionals involved in your care should be included in the process, with the arrangements recorded in your CTP.

• Crisis plan. Your CTP should also include a crisis plan setting out what you would like to happen if you become unwell again after you have left hospital. NICE guidance says that if you are considered to be at risk of suicide, arrangements should be made to follow up with you within 48 hours of you leaving hospital.