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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.

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:	Symplectic Administrator

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