The Care Programme Approach (CPA) has been in operation in England since 1991. The revised 2008 CPA (PDF) is for people with mental health problems who are at risk or have complex support needs. It requires agencies involved to work together to provide services through an individual care plan.
‘Recovery’ is being promoted as a way in which a person can ‘recover’ their life after a mental health crisis, which is different to being clinically ‘cured’ of a mental health problem. The approach has its origins in the service user movement. However, some mental health service users are questioning how ‘recovery’ is being interpreted by mental health practitioners who come from a medical perspective and wondering how the approach is being supported by the CPA.
The study covers the experiences of adults receiving mental health services through the CPA in London. It was led by Dorothy Gould, a researcher with experience of using mental health services. It is published as a full report and as an executive summary by the Mental Health Foundation and the National Survivor User Network.
The key aim of the research was to explore how effective the CPA is for promoting people’s recovery as they, rather than mental health practitioners, understand it. One of the other aims was to produce a practice checklist based on the research findings.
People receiving services through the CPA report that there can be marked differences between their own and mental health practitioners’ definitions of recovery. Although positive practice can be identified, the CPA only appears to be promoting service users’ own understandings of recovery in a ‘patchy’ way.
This largely qualitative piece of research was carried out by a team of researchers with experience of using mental health services themselves (user-researchers). The lead author is a user-researcher. It was supported by the Mental Health Foundation and took place between September 2011 and February 2012.
Eighty one participants who were over 18, living in a London borough and receiving adult mental health services under the CPA in London took part in the study. Forty seven percent classified themselves as ‘white’.
The researchers used a questionnaire and four focus groups. Twenty two participants attended the focus groups . Overall the participants were asked to consider questions covering the following areas:
- Their own and practitioner’s definitions of recovery
- What they thought was important for their recovery and if this had happened
- The part played by psychiatric diagnosis and medication
- The focus on risk
- Their experience of compulsory powers (such as ‘sectioning’)
- The use of anti-discriminatory approaches
- The use of recovery tools by practitioners
- What they would recommend to improve practice
Data was analysed using Excel spread sheets and framework analysis.
The study yielded wide-ranging results, the main ones being:
- Participants’ perceptions of recovery varied but the majority of focus group members thought the difference between their ideas and those of practitioners was unhelpful
- Women and people from black and minority ethnic communities were less satisfied about the extent to which practitioners acknowledged non-medical understandings of mental distress
- Feedback indicates areas of good practice, although this is ‘patchy’
- Participants stressed practitioner qualities such as compassion and honesty were as important as treatments
- All participants wanted a focus on whole-person and social approaches, rather than ones which emphasised medication and risk
- Recovery tools were thought to be ‘too set’ to suit everyone
- All participants stressed the need for practitioner time and reliable, flexible services
The author concludes that:
Overall, data from participants indicates that, whilst there is some evidence of good practice, services provided under the 2008 Care Programme Approach are patchy in the extent to which they promote recovery as service users understand it. There also appeared to be some particular issues for service users from marginalised communities
To summarise, this study offers an insight into recovery-based mental health practice from a service user perspective. The people participating in this study had particular experience of receiving mental health services through the 2008 CPA.
There are limitations because the study is a comparatively small one and solely based in London. Although there is a small amount of quantitative data from the questionnaires, it is largely qualitative in nature. Ideally a parallel study of CPA practitioner views of recovery would provide comparative data to strengthen the evidence on areas of difference.
Despite the limitations, the findings yield some useful recommendations for improving practice from a lived experience point of view. Among other things, the author recommends that practitioners and services:
- Acknowledge the fact that service users’ understandings of recovery are personal and varied and work with those concepts of recovery
- Work with individual service users to find the way(s) of understanding mental distress that prove most useful to them, rather than offering solely medical explanations
- Allow for the fact that personal qualities that mental health professionals bring with them are as important to service users as actual services
- Use treatment options to help services users live lives that they find meaningful, rather than as an end in themselves, and make fuller use of holistic approaches that any one service user says assists recovery
African American spoken word artist and mental health service user, Summer Breeze, tells mental health practitioners how recovery can be different from stability
Gould D (2013) Service users’ experiences of recovery under the 2008 Care Programme Approach London: Mental Health Foundation/National Survivor User Network
Gould D (2013) Service users’ experiences of recovery under the 2008 Care Programme Approach – Executive Summary London: Mental Health Foundation/National Survivor User Network
User-led research asks if the 2008 Care Programme Approach supports mental health service user understandings … http://t.co/Yjm2IkHgXz
Very interesting and worthwhile study results
#MentalHealth practitioners clinical understanding of #recovery can be limiting. New from @SchrebersSister http://t.co/Cs7o8DF0Mp
@Mental_Elf @SchrebersSister – Patchy – as in patched-up ?
@iamindependant @Mental_Elf Patchy – uneven, better in some places than in others, good & no so good depending where you are…
RT @pash22: Do mental health professionals understand difference between recovery and stability? http://t.co/uAjAtnZiWL via @sharethis via …
Pls RT @Rethink_ Mental health service users want to define their own #recovery story http://t.co/Cs7o8DF0Mp
Pls RT @MindCharity Mental health service users want to define their own #recovery story http://t.co/Cs7o8DF0Mp
@Mental_Elf @MindCharity yep. Finally someone starts to listen :-)
Pls RT @MHF_tweets Mental health service users want to define their own #recovery story http://t.co/Cs7o8DF0Mp
Pls RT @CharitySANE Mental health service users want to define their own #recovery story http://t.co/Cs7o8DF0Mp
Mental health service users want to define their own #recovery story. Read the debut blog of @SchrebersSister http://t.co/Cs7o8DF0Mp
@Mental_Elf Excellent stuff. So pleased @SchrebersSister now writing for you, too – no one better!
@Mental_Elf @schreberssister very useful and interesting piece of research. Going to send the link to my colleagues.
@Rachelrabs @Mental_Elf Thank you! :-) @NSUNnews did the research & you can download the full report from them…
MT Does the Care Programme Approach support mental health service user understandings of recovery? http://t.co/zfy38dHnyw via @Mental_Elf
Valuable user-led research on user perspectives about recovery: http://t.co/taNjYvr56u (via @Mental_Elf, written by @SchrebersSister)
User-led research asks if the 2008 Care Programme Approach supports MH users understandings of recovery http://t.co/86QHr5xG8t
User-led research asks what does ‘recovery’ mean for mental health? Not the same as ‘stability’ http://t.co/ozWzdkKeqw via @Mental_Elf
Read our blog on new user led research exploring how effective the CPA is for promoting people’s recovery http://t.co/Cs7o8DF0Mp
Mental health service users say that practitioner compassion and honesty are as important as treatments http://t.co/Cs7o8DF0Mp
@Mental_Elf #CAMH please note! #mentalhealth #SCAMH #TORONTO
@Mental_Elf Absolutely, and both of these attributes have been lacking in most medical professionals I’ve encountered.
Interesting from @Mental_Elf on a user-led piece of research looking at the Care Programme Approach http://t.co/ySaICznvoz
Qualitative study offers insight into recovery-based mental health practice from a service user perspective http://t.co/Cs7o8DF0Mp
User-led research asks if the 2008 Care Programme Approach supports mental health service user The Mental Elf http://t.co/roXKttL1TE
User-led research asks if the Care Programme Approach supports mental health service user understandings of recovery http://t.co/cMqApxwPrJ
RT @mgoat73: User-led research ask if Care Programme Aproach support #mentalhealth serviceuser understanding recovery http://t.co/j9Zl9Lg1cM
In case you missed it yesterday: Mental health service users want to define their own #recovery story http://t.co/Cs7o8DF0Mp
@Mental_Elf yes, please! Great for #recovery projects. Hope they have seen this: http://t.co/Fc8kF3KMwQ MH recovery-focused conference
User-led research asks if the 2008 Care Programme Approach supports mental health service user understandings of… http://t.co/HCq4mhY4IL
http://t.co/Hutjs9C5Fy User let research asks if CPA supports understanding of Recovery
I am a service user with vast amount of voluntary work in mental health issues not only at local level but at national level,and i would like to be involved in anything ragardind mental health.m.
[…] user research on recovery (again, blogged about by yours truly here) shows that people from black and minority ethnic backgrounds may have particular psychosocial […]