This audit is relevant to all secondary mental health in-patient and out-patient services, particularly services that have a large number of patients with severe mental illness of high complexity and risk, including patients with mild intellectual disabilities.
The Department of Health (2008) has issued new guidance on the implementation of the care programme approach (CPA). Previous categories of ‘standard’ and ‘enhanced’ CPA have been removed. The new CPA applies to patients previously meeting the criteria for ‘enhanced CPA’ (severe mental disorder of high complexity and risk and receiving support from multiple agencies). It also includes key groups such as those with parenting or caring responsibilities, history of substance misuse and a history of self-harm or violence.
The standards were based on the Department of Health 2008 guidance:
ᐅ patients on CPA have support from a designated, named care coordinator
ᐅ a comprehensive multidisciplinary assessment covers the full range of needs, including assessment of social care needs
ᐅ a comprehensive formal written care plan covers risk and safety, and includes a contingency and crisis plan
ᐅ a formal multidisciplinary review is done at least once a year
ᐅ ongoing need for new CPA support is reviewed
ᐅ advocacy support is available
ᐅ carers are identified and offered a carer's assessment.
Services should ensure that an up-to-date database is kept of all patients on CPA. The medical notes of these patients were examined. The following were recorded on a structured data-collection form:
ᐅ the presence of a CPA care plan in the notes for the past 12 months
ᐅ named care coordinator (and profession) on the care plan
ᐅ presence of risk assessment and whether it was updated following the previous CPA review
ᐅ documentation of contingency/crisis plan within the care plan
ᐅ documentation of social and physical issues in the care plan
ᐅ whether the next CPA date had been allocated. In addition to the above, the following could also be examined:
ᐅ whether there had been a discussion of the need for an advocate whether a carer's assessment had been offered to ᐅ the main carer (if applicable).