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British Journal of Social Work (2004) 34, 313-333
British Journal of Social Work 34/3 © BASW Trading Ltd 2004 all rights reserved
Integration and Targeting of Community Care for People with Severe and Enduring Mental Health Problems: Users’ Experiences of the Care Programme Approach and Care Management
Professor John Carpenter has been Director of the Centre for Applied Social Studies (CASS), University of Durham since 1997. He was previously Senior Lecturer in Applied Psychology at the University of Kent and Lecturer in Social Work at Bristol University. Dr Justine Schneider is Senior Lecturer at CASS having worked from 1991 to 1998 as Research Fellow in the Personal Social Services Research Unit, also at Kent University. Dr Toby Brandon is Senior Research Associate at CASS and Senior Lecturer in Disability Studies, University of Northumbria at Newcastle. Between 1997 and 2000, they completed a comparative study of community mental health services for the Department of Health.
Faye McNiven and Richard Stevens were research interviewers on the project. Other published papers from this study describe the operation and organization of community mental health services, the impact of service organization on multidisciplinary teamworking, the outcomes for users’ mental health and quality of life, the effects for carers and service use and costs. Other related studies of community mental health services include assertive outreach services and the outcomes of multiprofessional education.
David Wooff is Director of the Statistics Consultancy Unit, University of Durham. His work on applied statistics includes many projects with colleagues in CASS.
Correspondence to Professor John Carpenter, Director, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.ukJ.S.W.Carpenter@dur.ac.uk
Summary
We report the experiences of different models of community care of random samples of 262 people with severe and enduring mental health problems living in four districts in the north of England. The districts were characterized in terms of the extent of (1) integration between the health service-led Care Programme Approach (CPA) and social services Care Management, and (2) targeting of services on people with severe mental health problems. The majority of service users felt involved in planning their own care and considered that they had choice in their care and treatment when in the community, but not in hospital. Although all these users were formally subject to the CPA, the proportions of users in the districts believing they had a written care programme ranged between 37 per cent and 60 per cent. Of these, the great majority were very positive about their care programmes and felt that they were being helped to become independent. These results were replicated when 87 per cent of the original sample was re-interviewed six months later. There were significant differences between the four districts and evidence that users preferred an integrated health and social care service. In addition, a higher proportion of users in inclusive districts were satisfied compared to those in targeted districts. Notwithstanding these positive findings, there is still considerable room for improvement in relation to the involvement of family carers and the provision of adequate information about prescribed medication and making formal complaints.
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