Mental Illness in Britain - Term Paper Example

A REPORT ON THE CARE PROGRAMME APPROACH (CPA) WITHIN NHS INTRODUCTION Initiatives to systematise care needs of people with mental illness in Britain started in the early nineties. The Government in 1991 brought out a document named “Care Programme Approach,” (CPA) [seen in (2)] that defined the principles to address the care needs of patients with mental problems. Following on the initiatives, the Government made a press release in 1999 containing policy statements (1) “to drive up quality and cut wide variations in services” experienced across the country. This led to the release of the First National Standards for Mental Health. The scope of this report is to appraise relevant Government initiatives in taking healthcare policies forward, with particular reference to the CPA to serve as a basis for improved service planning for the future. The Government in 1999, brought out a document named “Effective co-ordination in Mental Health Services: A policy booklet modernising the Care Programme Approach.” One of the observations made this is that “Mental illness places demands on services that no one discipline or agency can meet alone.” (2) This led to recognition of the need for a system to effectively co-ordinate health, social care and related services “to work in harmony to the benefit of the service user.” (2 ibid) A major milestone that accelerated the pace of integrated health care service delivery was the issue of a White paper named “Our health, our care, our say: a new direction for community services,” (3) in January 2006. This White paper sets the baseline for healthcare services in the country for the future. This report aims to bring out an appraisal on the implementation of strategies, objectives and goals relating to healthcare underpinned in various Government initiatives to make the CPA for mental health services more result oriented. This aim is accomplished through a critical study of documents released by the Government from time to time, on implementation of the policies and programmes and on monitoring these and accomplishments reported. The findings include understanding of the policies initiated in 1991 through significant reforms brought out on the CPA since 1999, taking forward the initial policies, formulation of National standards on mental health and various other reforms that influenced the healthcare Sector as a whole. Documents researched particularly include reviews of the progress and effectiveness of the policies programmes and initiatives and improvements accomplished. FINDINGS The Care Programme Approach (CPA) The Care Programme Approach (CPA) for mental healthcare was conceived in 1991 (2 ibid) and was in operation from that time. The requirements defined in the document included: Assessing the health and social needs of people; Care plan to be provided by different service providers; Role of a “key worker” to monitor and co-ordinate care; and Systematic reviews to improve care plan. National Service Frame Work for Mental Health and the Modern Standards & Service Models The need to develop care standards arose from the observation (2) that: “Mental ill health is so common that at any one time around one in six People of working age have a mental health problem, most often anxiety or depression. One person in 250 will have a psychotic illness such as schizophrenia or bipolar affective disorder (manic depression).” The National Service Framework lays out the requirements for mental care. (4) Seven standards were formulated. The focus in the standards is to provide health and social services for working adults up to 65 years of age, while the principles apply to younger and older groups as well. Policies in these standards are given below under each head. Standard One (Mental Health Promotion) Health and social service personnel will ensure that they work together for promoting mental health in general. Standard Two & Standard Three (Primary Care and Access to Services) Patients with mental problems, will be afforded the opportunity to get their needs assessed and be offered appropriate treatments including referral to specialist services. Patients will be able to contact the local authorities round the clock to meet service needs. as need arises for first level advice and referral to specialist help lines or to local services. Standard Four & Standard Five (Effective Services for People with Mental Illness) All mental health service users should be given care and delivered with due caution to minimise risks or to prevent crisis. They should be provided with a copy of a comprehensive care plan. The care plan should be regularly reviewed and updated Service users requiring care should be able to get timely access to appropriate and available facilities as near to their homes as possible and be treated in a proper environment. When they are discharged, a written “after care plan” should be handed over. Standard Six (Caring about Carers) Those providing regular care for patients on CPA should maintain individual records containing assessment of physical and mental health needs. The care plan should be given to the patient. Such records should be updated at least on an annual basis. Standard Seven (Preventing Suicide) Possibility of any suicides by patients should be prevented through effective implementation of the other six standards. Improvements made on the First CPA Re-defining of the Government’s mental healthcare policies and concurrent introduction of NSF Mental Health Standards in 1999 entailed a review of the CPA-1991 for consistency with current thinking. Results of the above review, and changes needed are given in the publication “Effective care Co-ordination in Mental Health Services- A policy booklet modernising the Care programme Approach.” (5) Significant changes made are given in the following paragraphs: (i) Achieving integration For effective co-ordination among the agencies involved, the following plans are proposed: A single point of referral; A unified health and social care assessment process; Co-ordination of the respective roles and responsibilities of each agency in the system; and Access, through a single process, to the support and resources of both health and social care. (ii) Achieving consistency To unify care practices throughout the country; it was proposed to define two levels of CPA - respectively as “Standard” and “Enhanced.” The role of “Key worker” redefined as “Care co-ordinator” with redefined competence requirements and enlarged responsibility. (iii) Streamlining the process One of the operational constraints that came to light during review was that an “over-bureaucratic” system was in place. The proposed improvements are: Proposition of integrated and shared professional records Single system of referrals Maintenance of simple clinical/ practice records for such patients categorised under “Standard” category. Time bound abolition of Service registers Changing over to need based and flexible service users reviews instead of defined half yearly reviews. For improving effectiveness of the systems, it was proposed to give emphasis on qualitative aspects in the auditing process. (iv) Achieving proper focus Improvements proposed included needs of Risk Assessment Management, care planning for delivery, and provision of Support Service for Service users and their Wider Family. White Paper on Reforming the Mental Health Act A White Paper amending Mental Health Act 1983 was released by the Government in December 2000. (6) The amended act provides for compulsory treatment, assessment procedures, and extended care beyond hospital settings. Review of Implementation of the National Service Framework and the Modern Standards & Service Models Effectiveness of operation NSF upon completion of five years was reviewed in 2004 and a document to this effect was released (7) by the Government. The review mentions that substantial efforts put into the programme, resulted in services becoming more useful. White Paper “Our Health, Our Care, Our Say: a new direction for Community Services” The Government accomplished a major milestone in healthcare policies in January 2006, through publication of the White Paper named “Our health, our care, our say: a new direction for community services.”(3 Ibid) The paper aims to give a “new direction for social care,” to deliver “what people want and expect of services in the 21st century.” This Paper encompasses the entire range of health and social care needs of people in the country and the strategies to achieve the objectives. According to the new policies; many of the activities carried out at the Apex level are assigned to “Local Bodies” to work in co-ordination with other extended arms of the Government, “social enterprises and other third sector providers.” Our health, our care, our say: making it happen This publication was brought out in October 2006 (8) to take stock of the progress of implementation of the White Paper on healthcare published in January 2006, and to confirm action plans for the future. This document contains a “Road Map” for implementation of the programmes specifically covering: roles of Local Authorities, Public health and Social care authorities; methods of implementation of the service delivery programmes; identification of improvement areas through Service user feedbacks; re-designing service delivery processes based on feedbacks; and quality assurance plans. This document reviews the status of specific programmes such as “Payment by Results,” “NHS Life checks,” and Pilot projects planned and implemented. A process map giving the stages, controls and interactions among the various groups and service users may be seen in Annexure-1 of this report. Reviewing the Care Programme Approach 2006: A Consultation Document The CPA consultation document- 2006 (9) is intended to seek opinions from stakeholders. This document consolidates experience gained at different stages and critical views obtained from different quarters. On the basis of the findings on hand, questionnaires are framed dealing with different aspects, to seek written opinions from stakeholders, for consideration of need to make changes and improvements to the existing policies or to formulate new policies. The aim of the authorities is to collate the views obtained from stakeholders, review these and to update the policies for implementation from April 2008. Our health, our care, our say – one year on: research report The Government in March 2007 (10) conducted a half-day workshop designed to “refresh their (service user’s) awareness” on the Government’s programmes and to reveal details of some of the current programmes to get their opinions. The event was well attended and useful feedbacks were obtained. Mental Health Ten Years On: Progress on Mental Health Care Reform This is a paper prepared by the National Director for Mental Health in April 2007, (11) giving a critical assessment of the policies and programmes for the preceding ten year period. There have been significant additions in various categories of resource personnel to meet future challenges. The report also observes that the team for community care has also been enlarged and transformed into a large group. CONCLUSIONS The Government’s Care Programme Approach policies and Mental Health National Standards are well conceived and appropriate to deliver equitable service with justice to a vulnerable segment of the population namely those suffering from mental problems. Social care, social inclusion, “inreach,” “outreach,” “self care,” round the clock service, prevention of suicides etc. are well conceived ideas in management of mental care. The Government is in the process of bringing in more pragmatic policies on consideration of service users’ needs, and views of other stakeholders. Reforms to the current policies are expected to be finalised by April 2008. Judging from the progress if implementation of CPA and various other programmes initiated by the Government; it can be seen that a direction has been set and the objectives are achievable. The principle of involving health service users in improving service and service delivery process designs in mutual interaction is a commendable idea. It is expected that further improvements can be realised in all the service areas in course of time. It has also been demonstrated that Top level interactions, sample surveys, etc are also yielding results. Problems of changing over to a new system are more complex in an existing work environment than introducing a new system, however complex, in a virgin environment. When an existing system is already complex, the task of introducing revolutionary changes is even more difficult. It is therefore understandable that the process will take time. However with good planning and preparation, and with commitment at all levels, Briton’s healthcare system can be taken to a state of maturity in the next five years through consistent and dynamic planning ANNEXURE-1Process Map of Activities of Medical Care vested with Local Authorities (Adopted from the Publication named “Our Health, our care, our say: making it happen) (12) Explanations: PBC: Stands for Practice Based Commissioning, a scheme for providing incentives to healthcare team to promote care away from hospitals to minimise un-necessary stays in hospitals. PbR: Stands for Payment by Result, a scheme to measure output of or benchmark performance of Hospitals. DASS: stands for Director of Audit Social Services. DPH: Stands for Director of Public Health. LAAs Stand for Local Area Agreements dealing with work performance requirements and terms of agencies involved in accomplishing health and social care tasks. Notes (1) UK. Department of Health. (download). First National Standards For Mental Health. (2) UK. Department of Health. (download). Effective care co-ordination in mental health services: modernising the care programme approach - A policy booklet (3) UK. Department of Health. (webpage). Our health, our care, our say: a new direction for community services. (4) UK. Department of Health. (download). National Service Frame Work for Mental Health and the Modern Standards & Service Models (5) UK. Department of Health. (download). Effective care co-ordination in mental health services: modernising the care programme approach - A policy booklet (6) UK. Department of Health. (webpage). Mental Health White Paper (7) UK. Department of Health. (download). National Service Framework for Mental Health-5years on (8) UK. Department of Health. (download). Review of Implementation of the National Service Framework and the Modern Standards & Service Models-National Service Framework- 5 Years on (9) UK. Department of Health. (download). Reviewing the Care Programme Approach 2006- A consultation document (10) UK. Department of Health. (download). Our health, our care, our say – one year on: research report (11) Department of Health. (download). Mental Health Ten Years On: Progress on Mental Health Care Reform References (1) UK. Department of Health. (Webpage). (Accessed 15 May 2007). First National Standards For Mental Health. (30 September 1999) (1) Available from.http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4025628 (2) UK. Department of Health. (Webpage). (Accessed 15 May 2007). Effective care co-ordination in mental health services: modernising the care programme approach - A policy booklet (January 1999) (2). Available from. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009221 (3) UK. Department of Health. (Webpage). (Accessed 15 May 2007). Our health, our care, our say: a new direction for community services. (30 January 2006). Available from from.http//www.dh.gov.uk.Prod_consum_dh/idcplg?IdcService=GET_FILE&diD=456& (4) UK. Department of Health. (Download). (Accessed 15 May 2007) National Service Frame Work for Mental Health and the Modern Standards & Service Models (1999) Available from. http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=1890&Rendition=Web (5) UK. Department of Health. (Download). (Accessed 15 May 2007).Effective care co-ordination in mental health services: modernising the care programme approach - A policy booklet (January 1999). Available from. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009221 (6) UK. Department of Health. (Webpage). (Accessed 15 May 2007). Mental Health White Paper (20 Dec 2000). Available from. http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4009902 (7) UK. Department of Health. (Download). (Accessed 15 May 2007). National Service Framework for Mental Health-5years on.Available from. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4099120 (8) UK. Department of Health. (download). (Accessed 15 May 2007). Review of Implementation of the National Service Framework and the Modern Standards & Service Models National Service Framework- 5 Years on. Available from. http://www.dh.gov.uk/en/Publicationsandstatistics/ (9) UK. Department of Health. (download) (Accessed 15 May 2007). Reviewing the Care Programme Approach 2006- A consultation document- Care Services Improvement Partnership. Available from. http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_063354 (10) UK. Department of Health. (download). (Accessed 15 May 2007). Our health, our care, our say – one year on: research report http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Modernisation/Ourhealthourcareoursay/ (11) UK. Department of Health. (download). (Accessed 15 May 2007). Mental Health Ten Years On: Progress on Mental Health Care Reform. Available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074241 Read More