Leading mental health organisations have called for significant changes to be made to the Care Programme Approach (CPA) if it is to be effective in supporting service users in their recovery.

The call was made by the Mental Health Foundation, in partnership with NSUN network for mental health, at the launch of a new report, Service users’ experiences of recovery under the 2008 Care Programme Approach.

In a study for the report, participants highlighted a desire to move away from purely medical approaches to mental health care and more towards a whole-person approach. Perhaps more worryingly, the majority of participants who had been treated compulsorily under the Mental Health Act 2007 found that it had a negative effect on their recovery.

The CPA was introduced by the Government in 1990 when long-stay psychiatric services were closed and is designed to ensure that community mental health services work well for service users. The latest version of the CPA, from 2008, is intended to provide support for mental health service users who have wide-ranging needs, or are particularly at risk. It is especially important, therefore, that services provided under the CPA are of high quality.

The study for the report took place between September 2011 and late February 2012 as a result of service users’ concerns about the support that they were receiving under the CPA. The two researchers had personal experience of using mental health services and the 81 participants had all received services under the 2008 CPA.

Key points included:
• Recovery means different things to different service users and this needs taking fully into account. Services are patchy in this respect
• Service users who may face particular disadvantages in society often receive less helpful approaches and services. African, African Caribbean and female participants were especially concerned about this
• It is not helpful if medical diagnoses are the only explanations of mental distress provided, but this is too often the case
• Service users want warm, human qualities from mental health professionals to have at least as much focus as actual services and for there to be an increased move away from purely medical approaches to whole-person approaches
• While it is important to service users to feel safe, services can be too bound up with risk issues. Other important aspects of people’s lives are then overlooked
• Most participants who had been treated compulsorily under the Mental Health Act 2007 found that it had a negative effect on their recovery and that there was a tension between such powers and Government emphases on choice and empowerment
• Participants wanted to be more involved in their care plans and, frequently, to influence strategic decisions about services as well
• Shortfalls in staffing and funding need addressing if the 2008 CPA is to work well for service users.

Dorothy Gould, project lead, said: “This study shows that there is still a long way to go before people who draw on the 2008 Care Programme Approach find recovery services effective. Good practice seems to be selective rather than the norm, still more so in the case of service users from marginalised communities. Whether the approach in its current form is capable of altering the situation might itself be debated. Unless and until there is significant change, however, mental health service users will continue not infrequently to feel let down by the services on offer to them.” 

Eva Cyhlarova, head of research at the Mental Health Foundation, echoed these sentiments: “The results of this project illustrate that services provided under the 2008 Care Programme Approach do not adequately reflect service users’ concepts of recovery. Until service users’ views are fully taken into account and an holistic approach becomes the norm, it will continue to be difficult for people to achieve recovery. We hope that our research and recommendations will help mental health professionals address this issue and allow people with mental health problems to receive the support that meets their needs.”

Sarah Yiannoullou from NSUN agreed that the CPA process should be an holistic approach that aids recovery. “It should be used as effectively as possible to support this journey and help people to explore coping strategies and types of appropriate support and to think about their dreams and ambitions. This service user led research report highlights the importance of basic rights and values throughout the process and most importantly it emphasises the need to draw on an individual’s perception and description of recovery if the CPA is to promote it.”


Service users’ experiences of recovery under the 2008 Care Programme Approach can be downloaded for free here