User-led research asks if the 2008 Care Programme Approach supports mental health service user understandings of recovery

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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.

Vintage picture of nurse and medicine cabinet

Practitioner clinical understandings of recovery can be limiting

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.

Methods

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.

Results

Typewriter: Once Upon A Time

Service users want to define their own recovery story

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

Conclusions

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

Links

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

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Sarah Carr

Dr Sarah Carr is Senior Fellow in Mental Health Policy at the University of Birmingham and was formerly Associate Professor of Mental Health Research at Middlesex University London. She has experience of mental distress and mental health service use and uses this to inform all her work. Sarah is Acting Chair of the National Survivor User Network (NSUN) and a member of the editorial boards of Disability and Society and The Lancet Psychiatry. She is a National Institute for Health Research, School for Social Care Research (NIHR SSCR) Fellow, a Fellow of the Royal Society of Arts and a Visiting Fellow at the School of Social Policy and Social Work at the University of York.

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