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This essay will sketch and analyze the Care Programme Approach ( CPA ) , a societal policy which was introduced in England in 1991. it will critically analyze and measure how and why this policy ( CPA ) was introduced. In making so, it will try to research the societal jobs with which the policy was concerned, its ideological beginnings, its purposes and its nature. Finally, this essay will measure the effects of the execution of the CPA based on issues of entree and result.

What is societal policy?

Harmonizing to one web site I ‘ve consulted: The name ‘social policy ‘ is used to use to the policies which authoritiess use for public assistance and societal protection ; to the ways in which public assistance is developed in a society, and to the academic survey of the topic. In the first sense, societal policy is peculiarly concerned with societal services and the public assistance province. In the 2nd, broader sense, it stands for a scope of issues widening far beyond the actions of authorities – the agencies by which public assistance is promoted, and the societal and economic conditions which shape the development of public assistance.

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Social jobs with which the policy ( CPA ) was concerned

There are several societal jobs with which the CPA was concerned and some of them are: The 1984 slaying of societal worker Isabel Schwarz by a former mental wellness client as cited by Sharkey ( 2000 ) prompted a authorities enquiry that was led by Sir Roy Griffiths in 1988. His study “ Community Care: Agenda for Action ” was the precursor to the National Health Service and Community Care Act of 1990 ( NHSCCA ) which sets out the foundation for present twenty-four hours Care Programme Approach in England. The attention programme attack was besides instigated by the Christopher Clunis ‘ unmet demands as noted by the Ritchie Report in 1999. The study criticised the humbling failures of the wellness and societal services to work together in relation to the demands of people with mental wellness jobs and to protect the populace. The outgrowth of advocators groups such as MIND, the Mental Health Foundation and Informal Carers ‘ force per unit area group in the eightiess were besides major societal factors that led to the development of the CPA ( Morris ( 1993 ) . Those groups raise cardinal civil autonomy issues environing the legal rights of people returned back into the community from psychiatric infirmary and the demand for appropriate services. Another major concern harmonizing to Means and Smith ( 1998: p48 ) was “ the official study on Ely Hospital, Cardiff, which confirmed staff inhuman treatment to patients at this mental disability infirmary. ” They argued that “ The degree of media promotion generated by these incidents became so high that a policy response became inevitable ( ibid ) ” .

CPA ‘s ideological beginnings

There are several factors that affected the development and constitution of the Care Programme Approach ( CPA ) . However, the cardinal factors that influence the execution of the CPA are: political, economic and societal. From the earliest phases of the Poor Laws through to the present twenty-four hours societal security system, political factors have influenced welfare proviso. Like most other policies, the CPA emerge as a consequence of the conservativism New Right political orientation of minimal province intercession, denationalization, the thought of justness and the outgrowth of planetary market forces. The conservative authorities lead by Margaret Thatcher from 1979 through to the 1990s believed, politically, in cut downing the power of the local authorization and local authorities with the impression that “ attention in the community must progressively intend attention by the community ( Lavalette and Pratt 1998: 237 ) ” . Mrs Thatcher expressed the position that the forfeits which the household and voluntary organisations have played in community attention from the Victorian epoch to present twenty-four hours should non be seen as 2nd best or degrading. Her doctrine was built on the importance of assorted economic system, pick and given power back to the users of services. Mrs Thatcher was politically concerned with the political constructions of the local labour authorities and the demand to give more power to the market forces ( private sector ) to stimulate the economic system.

The attention programme attack policy was besides partially motivated by economic factors. The New Political Right regards the free market as the best manner forward for organizing society. They believed that a competitory market and a assorted economic system of public assistance is critical in promoting competition which inspires invention and efficiency which will inevitable supply better and cheaper services than a nationalised and bureaucratised services. This was a move off from the recognized orthodoxy of the Keynesian economic sciences which sees authorities intercession in the proviso of societal attention as necessary for the stableness of the economic system. The assorted economic system is hence seen by the New Right as non merely advancing equality and pick but besides cost effectual. Many believed that the political implicit in rule of giving service users pick would cover up the immense disbursement on the uncoordinated wellness and societal attention budget. As a consequence, both wellness and societal attention services were forced to present fiscal and direction systems in relation to the purchase of attention. For illustration, societal workers became attention directors and the buyers instead than the suppliers of attention.

Sing societal political orientation construct, the major societal political orientation was that, people with mental wellness jobs, were expected to be integrated back into the community with clear and structured attention programs. The fatal onslaughts by unsafe mentally sick people such as Christopher Clunis ‘s who was misdiagnosed and prematurely discharged so ended up killing an guiltless individual, were major societal factors which affected the development of the CPA. The instance of Clunis raised important societal issues of the hazard and danger posed by people with mental wellness jobs, particularly those non having proper attention. The instance besides raises major trans-cultural societal issues in relation to the important figure of black work forces placed on supervising registry.

The purpose of the policy

The Care Programme Approach was introduced in order to supply a clear model for the attention of people with mental wellness jobs outside infirmary ( Means and Smith1998: p156 ) ” , which Thompson et Al ( 2000:573 ) said this include: “ Systemic multidisciplinary appraisal, planning, monitoring, and reexamining a attention program, the inclusion of users and carers in the preparation and delivering of attention and designation of a lead individual or cardinal worker ” and that, “ all of this is undertaken within a model that is flexible and antiphonal to the client ‘s altering demands ( ibid ) ” .

Nature of the CPA

Harmonizing to Thompson et Al ( 2000 ) the CPA was introduced in 1991 and is intended to be the basis of the authorities ‘s mental wellness policy. This procedure applies to all people that are sing terrible mental wellness jobs who are clients of mental wellness services, whether on an informal or formal footing. The policy outlined four phases which should be applied to all clients in all instances. The First phase is, to transport out an appraisal based on the fortunes of the client, including any support needed by carers. Second, to negociate the attention bundle in understanding with the client, carers and relevant bureaus that are designed to run into the identify need within available resources. The 3rd phase is to implement and supervise the in agreement bundle by the assignment of a cardinal worker now known as “ attention co-ordinator ” . The attention co-ordinator is responsible for the appraisal and planning procedure. He or she could be a mental wellness nurse, societal worker or occupational healer. The last phase is, to reexamine the results of the attention program and if necessary undertake alteration of services provided.

The policy is based on person-centred attack and 1 that has been of import for wellness and societal attention to develop incorporate policies and processs around theoretical accounts of appraisal, diagnostic rating, integrated working relationships around attention programs and supervising people in attention and community by agencies of incorporate budgets. Whereas, pattern under old systems were non person-centred alternatively, they involved offering people limited figure of inflexible picks which were more or less organised to run into demands of service suppliers instead than the service users and their carers. With mental wellness placed in psychiatrist infirmaries or prisons these occupants are controlled and manipulated by those in charge.

The effects of the CPA

The policy helped services keep contact with service users, stressed the demand for service users involvement in determination devising ; ensures that there is coordination and communicating between all the professionals that are involved in the appraisal and bringing of the patient ‘s attention needs, but failed to supply comprehensive coordinated attention. This lead to several unfavorable judgment been made about the policy for illustration, it has been criticised that working together frequently leads to function insecurity and function ambiguity, therefore making a major hinderance to working together. The policy has besides been criticised for largely being used for inmates alternatively of people in the community. This was referenced by Sharkey ( 2000 ) as an of import point mentioning the Christopher Clunis ‘ instance due to the failure to offer culturally sensitive services to run into his demands and mentioning the illustration of Lavallette and Pratt ( 1998: 104 ) in which they commented that “ mental wellness policies and pattern based upon white European, middle-class norms of behavior can ensue in a system which does non understand that people from other cultural backgrounds may show symptoms of mental wellness or ill wellness in different ways ” . This is utile in enabling the apprehension of how Christopher Clunis was failed by all the professionals who saw him. For illustration, Sharkey ( 2000: p83 ) refer to the Ritchie Report that “ A GP whom Clunis had visited had struck him off his list because he was opprobrious and endangering ” .

The Mental Health Foundation carried out a recent surveies which aim was for respondents to speak openly about their mental wellness issues in relation to employment. They sent out about 3,000 questionnaire and those who replied, 86 % were white UK, 3 % Black African Caribbean, 2 % Black Asian and 4 % were other European white including Irish. What the findings has shown is that cultural minority are uncomfortable to speak about their mental wellness jobs for fright of favoritism and subjugation. They besides highlighted 85 % of those with long term terrible mental wellness jobs are unemployed. These can lend to the emphasis and anxiousness experienced by users, carers, friends and households. For illustration, populating with person with serious ongoing mental wellness jobs can do increased strain, concerns and straiten together with loss of friends and societal contracts ( illustration intimate relationships ) , societal isolation ( due to stigma attached ) and troubles in get bying with peculiar symptoms. At the same clip, the protection of the populace from the hazard of injury is of paramount importance because patients discharged without equal supervising or the proviso necessary to run into their lodging, societal and wellness demands would increase hazard to themselves and members of the populace as evident in the instance of Christopher Clunis. The CPA has besides been criticised as a policy that it is mostly dominated by medical faculty of intervention and societal issues are neglected by practicians and this has been highlighted by Thompson ( 2009 ) that spiritualty is really of import constituent of a individual ‘s wellbeing and despite this concern, people ‘s religious demands are frequently seen to be neglected during intervention or in developing and pull offing attention programs for daily activities. In some instances, as noted by, a charity candidacy for mental wellness consciousness, spiritualty is even seen as a manifestation of the persons ‘ psychosis or psychotic beliefs by some members of society. Even though the policy was introduced so that people with terrible mental wellness jobs could be assessed and assigned a attention coordinator so they do n’t show a hazard to themselves or the public, there have been some jobs with users of services “ stealing through the net ” and stoping up either homeless or doing jambons to themselves or others ( sometimes even perpetrating fatal onslaughts ) . For illustration, Taylor ( 2010 ) wrote on the Metro Newspaper about a adult male with mental wellness job who had n’t been offered intervention on several efforts ended up killing a pregnant adult female.


Even though this policy has helped people with terrible mental wellness issues to be integrated good into the community and unrecorded supported or independent lives, some people with mental wellness jobs are still seen by the policy shapers as a load and stigmatised as a menace to the community. They are routinely being denied the human rights of freedom of motion, household life, and equal entree to paid occupations and equal fiscal support which may so take to homelessness and readmission in institutional attention.

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