In this study we plan to find out how care is planned and organised in mental health services. We are interested to know whether and how care planning and coordination may focus on people’s recovery and be conducted in a personalised way.
We will do this by looking at how care coordinators assess, plan and coordinate care on a day-to-day basis. We will investigate whether staff work in partnership with users and carers, how they plan service users’ care, and how they work to address that care plan.
The study will take place in six different NHS Trust/Health Board sites in England and Wales and we will use a range of methods.
Interviews: We plan to interview 12 senior managers, 30 senior practitioners (e.g. Consultant Psychiatrists, Lead Nurses), 36 service users, 24 carers and 36 care coordinators.
Questionnaires: We will ask about 400 service users to complete three questionnaires about recovery, empowerment and therapeutic relationships and about 200 care coordinators to complete the same questionnaire about recovery.
We will also review local policies and audits about care planning and review 36 service users’ care plans. We hope to reveal the kinds of things that work best when helping people who have difficulties with their mental health.
There is already a system in place to plan and organise care for individuals with mental health difficulties. This system, called the care programme approach (CPA) or care and treatment planning (CTP), is seen as best practice in England and is now law in Wales.
All people under this system are meant to have a named worker (called a care coordinator) and a written plan to guide the care and treatment they get. These care plans should be specific to the person and help them in their recovery. We also know that people receiving help should be part of any decisions made about their care.
However, even though the CPA/CTP is part and parcel of how care is organised and delivered to people with mental health problems in England and Wales it is surprising how little research has been done on how this system works, and why it sometimes doesn’t.
The evidence for similar systems of care shows that they help people stay in contact with services but also increase admissions to hospital and have little effect on the symptoms people have. We also know that if workers focus more closely on getting to know the person and agreeing plans with them they tend to do better.
However, people may need to be helped to become better involved in their own care and how workers do this seems to be important.The system of care that currently exists has some faults. These faults include too much paperwork, and too much time for care coordinators away from service users. What happens within care teams also seems to be important in deciding the quality of care received.
Even when the CPA/CTP is used many people say they are still uncertain who their care coordinator is, have not been offered a copy of their care plan or don’t understand what is in them. Some also say that their plans don’t take into account their views of what is needed. We also know that for the minority of people with mental health problems who go on to harm others this care system has not been properly used in many cases.
Our aim is to get close to day-to-day work in typical mental health teams in order to find out what is really going on in care planning and care coordination, and to share the information we find with people in a position to improve the planning and delivery of care to people with mental health problems.