Kelly M
Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, UK.
J Psychiatr Ment Health Nurs. 2017 Aug;24(6):396-402. doi: 10.1111/jpm.12398. Epub 2017 Jul 4.
WHAT IS KNOWN ON THE SUBJECT?: People with mental health problems and learning disabilities often do not receive the care they require. The Care Programme Approach (CPA) is meant to help with this. However, there have been many problems in the past with the introduction of the CPA into mental health services. There is no literature which explores what factors help or hinder the introduction of the CPA for service users with a mental health and learning disability, especially from the perspective of those responsible for overseeing this process. WHAT DOES THIS ARTICLE ADD TO EXISTING KNOWLEDGE?: The implementation of the CPA for this service user group is fragmented, and services are not working together in partnership. The CPA is being effectively implemented for people who are deemed to present with a risk to themselves or others. If a service user does not present with a high risk, they are not provided care through the CPA. Service users were not involved in the development or introduction of the policy in practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to work better at engaging service users when they are developing and introducing new policies. Rather than applying the CPA for all service users, across all services, it should only be considered for those deemed to present with a high risk. It is effectively implemented for these people. For those not deemed to present with a high risk, services should consider using alternative service user led care planning frameworks.
Introduction The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership. Aim This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis. Method A single case study approach was undertaken. Data were collected through interview (n = 26), documentary analysis (n = 64), steering group observation (n = 3) and the Partnership Assessment Tool (n = 26). Data were analysed using the Framework Approach. Results The CPA was only effectively implemented for people who were deemed to present with a high level of risk. Discussion The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery. Implications for practice Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users.
关于该主题已知的信息有哪些？：有心理健康问题和学习障碍的人群往往无法获得他们所需的护理。护理计划方案（CPA）旨在解决这一问题。然而，过去在将CPA引入心理健康服务方面存在诸多问题。目前尚无文献探讨哪些因素有助于或阻碍为患有心理健康问题和学习障碍的服务使用者引入CPA，尤其是从负责监督这一过程的人员的角度。本文对现有知识有何补充？：针对这一服务使用者群体，CPA的实施是零散的，各服务机构并未形成合作关系。对于那些被认为对自己或他人构成风险的人，CPA得到了有效实施。如果服务使用者不存在高风险，他们就无法通过CPA获得护理。服务使用者在政策的实际制定或引入过程中并未参与。对实践有何启示？：各服务机构在制定和引入新政策时，需要更好地与服务使用者进行沟通。不应在所有服务中对所有服务使用者都应用CPA，而应仅考虑那些被认为存在高风险的人，因为CPA对这些人得到了有效实施。对于那些被认为不存在高风险的人，服务机构应考虑使用其他由服务使用者主导的护理计划框架。
引言 护理计划方案在英格兰被引入，以确保服务能够满足有心理健康问题且同时存在学习障碍（双重诊断）的人群的需求。CPA的实施并不完善，各服务机构未能形成合作关系。目的 本研究旨在探讨影响近期为双重诊断服务使用者实施CPA的因素。方法 采用单一案例研究方法。通过访谈（n = 26）、文献分析（n = 64）、指导小组观察（n = 3）和伙伴关系评估工具（n = 26）收集数据。使用框架分析法对数据进行分析。结果 CPA仅对那些被认为存在高风险的人得到了有效实施。讨论 对于双重诊断的人群而言，20世纪90年代与实施相关的问题在近期仍持续存在。CPA已与风险管理协议更加契合，而非支持个体服务使用者的康复。对实践的启示 服务使用者应参与对其康复有影响的政策的实施。CPA应仅应用于那些存在高风险问题的人，而对于其他服务使用者应考虑其他由用户主导的举措。
