City Research Online

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

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.

Publication Type: Article
Publisher Keywords: Care Programme Approach (CPA), Case Management, Community Care, Multi-disciplinary Teams, Teamwork
Subjects: R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Nursing
SWORD Depositor:
[thumbnail of The_History_of_the_Care_Programme_Approach_in_England.pdf]
Preview
PDF - Accepted Version
Download (307kB) | Preview

Export

Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email

Downloads

Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login