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Getting care for someone experiencing mental health problems

Care Programme Approach (CPA)

For people with severe mental health problems, a care plan will be developed as part of the Care Programme Approach (CPA).

You may be invited to a CPA meeting, if your relative wishes, where you will meet the Multi-Disciplinary Team (MDT). The purpose of this meeting is to develop a Care Plan for your relative, that supports their recovery. You can ask for a copy of how the service carries out their Care Programme Approach.

As a part of this process you may be offered a Carer’s Assessment, to which you have a statutory right under the Care Act 2014. As a part of the Carer’s Assessment, a Care Plan for you as a relative will be developed. To find out more go to the carers assessment page.

What to expect from a CPA meeting

You will be introduced to all the people involved in your relative’s care. As part of the CPA meeting the person experience mental health problems should have:

  • support from a CPA care coordinator
  • a full assessment of their needs, taking account of all the services who will be giving them support
  • a written care plan, which includes plans for risks your relative may face and what should happen if they are in crisis
  • ongoing review of their care, including a full review of all the support they are receiving from all services at least once a year
  • consideration of ongoing need for CPA support
  • consideration of their need for support from an advocate
  • support for you as a carer. This means you as a carer should be identified, and told of any rights you have to have your needs assessed. This is to find out if you need help to give your relative care.

Care Plans: Getting Support for your relative

There are two different types of care plans, care plans to support the recovery of the person experiencing mental health problems or for you as a relative. This page relates to a care plan to support the recovery of the person experiencing mental health problems.

A care plan is an agreement between health and social care services, the service user and their supporting relatives or friends. It is an agreement about what support will be provided and who by.

The Care Act 2014 outlines the process for assessing need and providing care, people experiencing mental health problems. This is described below. Some mental health services may not yet have updated their processes to meet these standards. To read more about the Care Act follow this link : www.peoplefirstinfo.org.uk/money-and-legal/care-act-2014/the-care-act-an-overview.aspx

Everyone involved should be consulted (including relatives) and should have their views taken into account.

There are 4 key steps:

1. Assessment of needs – this should be done first and on the basis of what is needed rather than what is affordable.
It must:

  • cover the full range of needs of adults with care and support needs and their carers
  • focus the assessment on the person’s needs and how they impact on their wellbeing,and the outcomes they want to achieve
  • involve the person in the assessment and, where appropriate, their carer or someone else they nominate
  • provide access to an independent advocate to support the person’s involvement in the assessment if required
  • consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

Whoever carries out the assessment has to gather information from anyone who knows the person and the situation, has to provide a list of the questions before any interview, and send a copy of their conclusions to the individual and the relative. If you don’t agree with the assessment you have a right to challenge what it says.

The assessment is not simply a ‘snapshot’ of a person’s care and support needs. Local authorities must consider the person’s care and support needs over a suitable period of time to gain a complete picture of those needs. This is especially important in mental health where someone’s symptoms and needs fluctuate.

 

2. A decision from those providing support (Council / NHS organisation) about which needs it will meet. This cannot be made just on the basis of what the organisation can afford, or what services it already has. Every effort must be made to ensure that needs are met.

 

3. A care plan with full details of what will be done to meet the needs the assessment has identified, and a list of any needs that can’t be met. It should explain exactly what will be done, when and how, and who will do it. Relatives should have a copy of the care plan and should be in agreement with anything they’re asked to do as part of this plan. Relatives can choose not to provide care, in which case the plan should say who will be meeting the needs the relative might have been expected to provide.

 

4. Decisions about how the planned support will be paid for. This is a complicated area, and may differ from one Local Authority to another. It’s usually means tested, and people may be asked to make some contribution to the services they receive. However if someone has been sectioned under certain sections of the Mental Health Act they are entitled to what’s known as ‘Section 117’ aftercare for which they or their relatives can’t be charged.

 

What is in the Care Plan?

Information included as standard:

  • Contact details of everyone concerned
  • When this plan was written and who wrote it
  • Signs of relapse and crisis / emergency contacts
  • Who has agreed this plan and whether it was rejected by either the patient or the relative
  • Note of whether the patient/relative have received copies of the plan
  • Strengths of the patient
  • Their needs and problems and what actions will be taken to address these
  • Who will take the actions identified in the plan
  • What outcomes are expected
  • Details of any personal budget / direct payments provision
  • Date and time of next review meeting

On top of this, the plan should go into full detail about each area of need or problem. Needs and problems are organised into the 9 domains in the Care Act that are important to Wellbeing. It should then show how these will be dealt with, and which of the 10 Care Act Outcomes this should achieve.

All mental health services will have their own way of doing this, but this could be an example of how one particular need is being catered for:

Domain

Suitability of living accommodation / control over everyday life.

Ryan’s needs in this domain

If Ryan’s house is dirty and his laundry not done, he becomes depressed and anxious. He needs a smooth domestic life to enable him to take part in activities. If his house is in chaos he is overwhelmed with tasks, can’t decide which to do first and in what order, and doesn’t do anything. He then feels ashamed of himself.

How will these needs be met?

Ryan will have 9 hours per week from a Personal Assistant to help him decide what needs to be done, to prompt and motivate him, and to encourage him to complete tasks.

Which Care Act outcomes will be targeted?

Maintaining a habitable home environment / making use of facilities in the community.

What will be the outcomes for Ryan?

Ryan will have a clean and ordered home, feel less anxious and more confident about managing this for himself, and be able to take part in outside activities such as sport. He will be able to be in control of his daily life (e.g. will have clean clothes ready for such activities) and take pride in what he can achieve.

 

What happens to the Care Plan?

Copies of the care plan should be given to:

  • The person with psychosis / bipolar disorder
  • Relevant health professionals involved in delivering the care plan
  • Relatives / friends providing support

If you are mentioned in the care plan as providing some of the care then you must have a copy for yourself. If your relative does NOT want you involved in this plan, then you can still receive help from the mental health services, but they may not be able to share some details of the Care Plan with you (see discussion of ‘Information Sharing and Confidentiality’ later in this section).

Check the care plan carefully and ask the Care Co-ordinator to change things that you’re not happy with. Then check that what is written on the plan actually happens.