Care Programme Approach

Care Programme Approach
Name	Care Programme Approach
Type	Mental health care coordination framework
Introduced	1990
Originating country	United Kingdom
Legislation	Mental Health Act 1983; National Health Service reforms

Care Programme Approach is a statutory framework for assessing, planning and coordinating community mental health care in the United Kingdom. It was introduced to ensure systematic assessment, individualized care planning and clear allocation of responsibility for people with severe mental health problems. The model links service users with multidisciplinary teams and statutory authorities to manage risk, rehabilitation and social support.

History and development

The approach was introduced following reviews and reports such as the Risley Committee, the Royal College of Psychiatrists inquiries and major policy documents from the Department of Health and Social Care and the National Health Service management reforms of the late 1980s and early 1990s. It emerged amid debates captured in publications by the King's Fund and the Institute of Psychiatry, Psychology and Neuroscience, and was influenced by European movements including reforms in Sweden and the Netherlands toward community psychiatry. Subsequent legislation, including amendments to the Mental Health Act 1983 and guidance from agencies such as the Care Quality Commission and the National Institute for Health and Care Excellence shaped implementation. Academic evaluations from universities such as University College London, the University of Manchester and the University of Glasgow documented variable uptake, prompting revisions in policy documents from the Scottish Government and Welsh Government.

Eligibility and assessment

Eligibility criteria were defined in guidance produced by the Department of Health and Social Care and regional health authorities, targeting adults with severe mental disorders previously subject to long-term inpatient care, including diagnoses recorded in services influenced by the International Classification of Diseases and assessments informed by instruments developed at institutions like the Maudsley Hospital. Assessment processes involve multidisciplinary mental health teams drawing on social care histories held by local authorities such as London Borough of Hackney or county councils like Lancashire County Council, and risk appraisals influenced by case law such as R v. Bournewood Community and Mental Health NHS Trust and standards set by the Mental Capacity Act 2005. Forensic, child and adolescent, and older adult services in trusts such as Cambridge University Hospitals and Oxford Health NHS Foundation Trust adapted eligibility thresholds to local pathways.

Care planning and coordination

Care planning under the approach requires documented care plans integrating clinical interventions from teams associated with hospitals like Royal London Hospital, psychosocial therapies developed at centres including the Tavistock and Portman NHS Foundation Trust, and social support arranged via local authorities and housing providers such as Peabody Trust or voluntary organisations like Mind. Coordination commonly involves regular reviews, crisis contingency plans and discharge arrangements linked to community services provided by bodies such as Barnardo's, Rethink Mental Illness and community mental health teams within NHS trusts. Information exchange and record-keeping practices have been informed by guidance from the Information Commissioner's Office and electronic systems used by providers including NHS Digital.

Roles and responsibilities

Key roles include designated care coordinators drawn from professions represented by the Royal College of Nursing, the Royal College of Psychiatrists and the British Association of Social Workers, supported by psychiatrists trained at institutions like King's College London and psychologists affiliated with the British Psychological Society. Local authority social workers, housing officers from organisations such as Shelter (charity) and employment advisers from schemes influenced by Department for Work and Pensions policies contribute statutory and non-statutory inputs. Commissioners in clinical commissioning groups and integrated care boards including NHS England oversee resource allocation, while inspection bodies including the Care Inspectorate and Care Quality Commission monitor compliance.

Implementation and variations

Implementation varied across NHS trusts, local authorities and devolved administrations such as Scottish Government and Welsh Government jurisdictions, producing different models in urban centres like Greater London and rural counties such as Cumbria. Some areas integrated the approach into assertive outreach teams modelled on Hengistbury Head-style community services, while others developed enhanced versions incorporating recovery-oriented tools from programmes pioneered at St Patrick's University Hospital and collaborative care pilots evaluated by the Nuffield Trust. International adaptations and comparative studies examined parallels in systems in Canada and Australia, and service redesigns responded to audits by bodies such as the National Audit Office.

Outcomes and criticisms

Evaluations by academic centres including University of Birmingham, policy analyses from think tanks such as the Health Foundation and inspectorate reports by the Care Quality Commission identified benefits in improved documentation and clearer accountability but highlighted inconsistencies in implementation, variability in care-coordinator caseloads, and limited impacts on outcomes such as reduced readmissions in studies published through the London School of Hygiene & Tropical Medicine. Criticisms invoked concerns from advocacy groups like Samaritans and Mind about bureaucratic burden, risk-averse practices and insufficient attention to social determinants addressed by organisations such as Joseph Rowntree Foundation. Reforms and alternatives have been debated in forums hosted by the Royal Society of Medicine and piloted in partnership with service user networks like National Survivor User Network to address gaps in continuity, person-centred planning and integration with primary care providers such as NHS Ayrshire and Arran.

Category:Mental health in the United Kingdom