The care programme approach (CPA) is essentially a system used to deliver health services to individuals with mental illness in society. It was primarily introduced to the United Kingdom healthcare system in 1991 (Department of Health Services. 2002 pp. 6-9)1 and has since become fundamental to the healthcare system in the country. Before an individual or group of individuals receive any healthcare services, assessments are carried out to determine the degree of need. These needs-based assessments are in two distinct forms, individual needs assessments and assessment of the needs of the population for specialist psychiatric care. Thornicroft (2001 pp.162)
The need to make the care programme approach is so as to ensure that the unique needs of individuals are taken into account during the care-giving process. (Cohen, Singh, Hague 2004 pp. 7-9)2. “Client-centred processes are based on paying attention to what the people themselves want and help them live normal lives in their communities. These approaches ensure that the interventions are designed to suit the service to the individuals and not vice versa as would be the case if one standard were applied to all clients. Centre for policy and ageing (2008).
As argued by the Centre for Policy on Ageing, the assessment process can be made more client-centred by the effective sharing of information between the network of agencies responsible for the care of individuals in the various communities. It is however important to note that the sharing of electronic records around the country’s agencies is subject to permission from the individuals. Centre for Policy and Ageing (2008).
Communication is an important aspect of assessment as it allows the caregiver to effectively gauge the degree of help required by an individual or group of individuals. The nurses are the health professionals that people experiencing affective disorders such as depression and psychosis are most likely to deal with first in the healthcare process. Curran, Wattis and Wilson (2008 pp.173). This, therefore, makes it imperative for the nurses to learn effective communication skills as they are a critical part of the assessment process as they promote communication methods. The nurses are knowledgeable as they play a key role in interpreting the technical and health information that is often part of the assessment process. (Ivanov and Blue. 2008 pp.44)
In any caregiving, the involvement of the family is important as it helps in the healing process (Wood et.al. 2007 pp.116). In the care programme approach assessment, it is necessary to have a system of care that fully integrates families and offers real choices for participation and involvement. This active involvement of the family thereby improves the state of the client as frequent interaction with loved ones usually hastens the healing process or at the very least cause’s relaxation due to familiarity.
Discrimination and stigma in society about mental illness usually stem from public perception and stereotypes about mental disorders. Schultz and Roger (2000 pp.58). This kind of discrimination bears negative effects for the clients because the constant expressions of pity, anger and fear from the rest of the community have a paralyzing effect on the clients. Uys and Middleton (2004 pp.75) state that all negative perceptions of mental illness are informed by ignorance of the condition and its treatment as people are often afraid of what they do not understand. As a result of the gravity of the effects of stigma on the clients should be addressed by all nurses whether or not the nurse practices psychiatric nursing. To reduce the burden of mental illness and improve the degree of access to relevant care, nurses can educate all their patients on symptoms and treatment of mental illness. (Boyd. 2008 pp.53).
The issue of mental health clients bearing children has always been a controversial issue that has been discussed over the years. The safety of the child has always been one of the key issues along with the care of the child after birth. Nurses have to consider the safety of children when dealing with clients while at the same time taking into consideration the wellbeing of the client. In relation to this nurses are bound to notify the social services department if their assessment of the patient’s mental state informs them that the unborn baby may be at risk in their custody and therefore should be removed. (Sugden. 1986 pp. 117 ).
The recovery process for mental illness clients is a hard process, a process where their own active involvement is very important to hasten the process of healing. persons with mental illness may be chronic and unmotivated, especially those who had been ill for a long time and frequent admission to mental hospitals. They may be inert, passive, withdrawn and unmotivated to participate in interventions and services. (Yip. 2007 pp.50). It is especially such clients who need to be actively involved in their recovery process because the underlying feelings of helplessness are detrimental and manifest themselves in the form of a relapse of the illnesses. Supporters of client involvement in the recovery process have been active in the process of making the voices of people with mental illness heard and are raising awareness that an understanding of the subjective experience of mental illness is essential to recovery services. Chang & Johnson (2008 pp.190)
The clients’ autonomy to make their own decisions during the recovery process is also essential as is involved in their own care. At the core of integrated treatment is the principle of shared decision-making between the stakeholders. This is on the premise that integrated treatment for clients is the best, case in point those with either severe mental illness is capable of playing a vital role in the management of their disorders and in making progress towards achieving their goals. Mueser et.al (2003 pp.20)
The assessment of clients on medication by their nurses and caregivers is essential so as to monitor the effects of the medication on the client. In addition to this, without direction, the client may consume other drugs or substances that may conflict in the system with other prescribed medication for the mental disorder. Elder et.al (2009 pp.361) state that alcohol and other drugs, even at low levels of consumption can interact adversely with most of 0the medications commonly prescribed for the treatment of mental problems. For the well-being of the client, it is imperative that their sense of pride and independence is not affected by their condition and management of it. For example, the primary reason why caregivers involve their clients in choosing and maintaining their housing is that they are more likely to function better in that housing if they choose it. Linhorst (2006 pp.118). From the assessment process, students can derive that there is a serious need to individualize the caregiving process to ensure that services rendered to the mental illness clients are relevant to their disorders and specifications. In addition, the overall management of clients is also to be undertaken by individuals keen to better the lives of their clients and hasten the healing process.
In conclusion, Goodwin and Smith state that an active integrated care policy should be all-inclusive, involving all parties involved in the CPA, and each person should play a part for the CPA to attain its purpose and intended goals. Although CPA in England has had implementation challenges, a few lessons learnt suggests that there is potential for better care integration and CPA could play a major role in the management and care of people with chronic and sometimes complex needs.
Boyd, M.A. (2008) Psychiatric Nursing: Contemporary Practice. 4th ed. Lipincott Williams & Wilkins, New York.
Chang, B. and Johnson A. (2008) Chronic Illness and Disability: Principles of Nursing Care. Elsevier Publishers, Australia.
Centre For Policy on Ageing (2008) Person Centred Approaches to Care. C.P.A. London.
Cohen, A. Singh S.P. and Hague, J. (2004) The Primary Care Guide to Managing Severe Mental Illness. The Sainsbury Centre for Mental Health, London.
Department of Health Services. (2002) Modernising the Care Programme Approach. London: Government Publishers. pp. 6-9
Elder, R. and Evans, K. and Nizette, D. (2009) Psychiatric and Mental Health Nursing. Elsevier Publishers, Australia.
Goodwin, N. and Smith, S.L. (2010) Integrating Care for People with Mental Illness:The Care Programme Approach in England and its Implications. International Journal of Integrated Care, Vol. 10(March),pp. 54-56.
Ivanov, L. and Blue C.L. (2008) Public Health Nursing: Leadership, Policy and PracticeDelmar Engage Learning, U.S.A:
Linhorst, D.M. (2006) Empowering People with Severe Mental Illness: a Practical Guide. Oxford University Press, U.S.A
Mueser, K.T. et.al. (2003) Integrated Treatment for Dual Disorders: A Guide to Effective Practice. The Gulford Press, New York.
Schultz, I.Z. and Rogers, E.S. (2006) Work Accomodation and Retention in Mental Health.University of British Columbia, Vancouver
Sugden, J. (1986) A Handbook for Psychiatric Nurses. Taylor and Francis, London.
Thornicroft, G. (2001) Measuring Mental Health Needs. Royal College of Psychiatrists, London.
Uys, L. and Middleton, L. (2004) Mental Health Nursing: A South African Perspective. Juta and Co. Ltd., Cape Town.
Wood, B. et.al. (2007) Involving Families in Care Homes: A Relationship Centred Approach. Jessica Kingsley Publishers, New York.
- 1 More details on the structure were discussed in Moderising the Care Approach pp.6-9
- 2 This same point is highlighted by Cohen A., Singh, S.P and Hague, J. pp. 7-9