Care programme approach does not focus on need for services

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7061.884b (Published 05 October 1996) Cite this as: BMJ 1996;313:884
  1. Emad Salib, Consultant psychiatrist,
  2. Ann Joseph, Senior house officer in psychiatry
  1. Winwick Hospital, Warrington Community Health Care (NHS) Trust, Warrington WA2 8RR 1

    EDITOR,—John A Dennehy and colleagues comment on the limited value of the care programme approach in identifying the risk of suicide in psychiatric patients.1 Similar findings were observed when documentation relating to the care programme approach was studied for all psychiatric patients from Warrington who died unexpectedly of unnatural causes and were the subject of a coroner's inquest since the implementation of the approach some four years ago.

    Of the 31 patients identified, 19 were on the register for the care programme approach and had had at least one admission since the introduction of the approach. Ten of the patients had required admission to hospital in the year that the death was reported. Only nine of the 19 patients on the register had an identifiable care plan for low or medium intensity care. None of the patients had a full care programme of the type normally reserved for patients with serious mental illness and those considered to be at a distinct risk. A suicide verdict was recorded for seven patients, only three of whom had an identifiable care plan, and a verdict of misadventure or an open verdict was recorded for 12, six of whom had an identifiable care plan. Although lengthy documentation for the patients showed that some needs had been identified, there was no mention of risk of suicide or any other risk or unmet needs for any of the patients who had a care plan and an identifiable key worker.

    We agree with Dennehy and colleagues that the care programme approach does not seem to detect unmet needs or risk of suicide in this vulnerable group of patients. It seems to focus on service needs and not on need for services, with an increasing emphasis on the completion of numerous forms. There is a danger that the excellent concept of the care programme approach may end up as yet another exercise in paperwork that does not work.


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