The History of the Care Programme Approach in England: Where did it go wrong?

Simpson, A., Bowers, L. & Miller, C. (2003). The History of the Care Programme Approach in England: Where did it go wrong?. Journal of Mental Health, 12(5), pp. 489-504. doi: 10.1080/09638230310001603555

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Abstract

Background: The Care Programme Approach (CPA) was introduced in England in 1991 as a form of case management to improve community care for people with severe mental illness. It helped services maintain contact with users but failed to provide comprehensive, co-ordinated care and is associated with increased bed use. Aim: To describe and evaluate the introduction, implementation and development of the CPA and identify reasons for its relative failure. Method: A critical review of key events, audits, reports, research and policies that shaped the CPA. Results: Reasons for the relative failure of the CPA included the socio-political and financial context, clinicians’ resistance to political and managerial interference, and the bureaucratic, complex and time-consuming nature of the policy. This reduced face-to-face contact whilst contributing to an emergent ‘blame culture’ and defensive psychiatric practice. The CPA also presumed levels of community resources and interprofessional teamwork that were frequently absent. mConclusions: The CPA was a flawed policy introduced insensitively into an inhospitable environment. It was destined to fail and after more than a decade remains ineffectively implemented. Changes introduced recently may have contradictory influences on the ability of services to provide effective case management but remain to be evaluated. Declaration of interests: This paper is derived from work undertaken by Alan Simpson under the supervision of Carolyn Miller and Len Bowers, as part of a Research Training Fellowship, funded by the NHS Executive South-East and supported by South Downs Health NHS Trust.

Item Type: Article
Uncontrolled Keywords: Care Programme Approach (CPA), Case Management, Community Care, Multi-disciplinary Teams, Teamwork
Subjects: R Medicine > RT Nursing
Divisions: School of Health Sciences > Department of Adult Nursing
URI: http://openaccess.city.ac.uk/id/eprint/8075

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