How can we make the Care Programme Approach more person-centred?

The Care Programme Approach (CPA) includes reviews that were always intended to be person-centred, but this is often not the experience of the people who need support.

In a traditional CPA review, professionals meet with the person and possibly family members. Everyone present can take turns to speak, and professionals may refer to or read out reports they have compiled. Many people have reported that they felt intimidated by the process, and so they might not express how they are really feeling.

Marianne Selby-Booth from Certitude talked with people who use mental health support, to find out what their experiences were of reviews in a variety of settings – including CPA meetings, key worker meetings, Recovery Star meetings and review meetings while in hospital.

The group talked about how reviews can still cause a great deal of stress, anxiety and resentment. This was felt most strongly about CPA meetings, where examples were given of having to wait to be invited to your own meeting, not being allowed to bring your advocate or friend into your meeting and professionals coming in and out of the meeting, staying only for the bits that concern them. One person described the shock they felt when they were once offered a cup of tea at their CPA meeting. It would appear that refreshments and putting people at their ease are not the norm!

‘If I suggested my CPA was held in a café instead of at the hospital, they would think I was really mad and probably section me.’

Although said as a joke, this person’s comment reflects the feelings of many that their mental health can be used by professionals as a reason not to work in partnership with them, further exacerbating the lack of control felt.

Elizabeth is a team leader for a Child and Adolescent Mental Health Service intensive outreach team. She has been working with Henry, an ‘in-patient’, for quite some time. She felt that his views weren’t being heard. She was asked by his CPA coordinator to facilitate his CPA review, and Elizabeth set about doing this in a person-centred way, using the person-centred review process.

She looked at the statutory requirements of a CPA review and its various headings – finance, housing, mental and physical health, activities and family/social/community support – and realised that they could comfortably fit with the headings used in the person-centred review process.

Elizabeth prepared Henry for his next CPA review by going over what they would use and how they would be doing things. They also talked about how he wanted to be involved. She put the previous CPA action plan on to flipchart paper and added columns for a tick or a cross. Henry filled this in as they went through the plan, ticking something if it had been achieved and putting a cross if not. They had sheets for people to sign in, to say what they liked and admired about Henry, and for questions to ask and issues to raise. They set the chairs in a semi-circle facing the action plan, with Henry and Elizabeth sitting together to one side at the front. Henry was introduced to everyone in the meeting and got the opportunity to express his feelings about what was working and not working from his point of view.

This meeting had a very different feel about it from the first. All the professionals and others involved directed their comments and conversation to Henry, so that it was far more open and genuine. It is just one example of what can be achieved when taking a person-centred approach.

To learn more about CPA and person-centred practices, you might find the book ‘A practical guide to personalisation’ useful.

 

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