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

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 careof random samples of 262 people with severe and enduring mentalhealth 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) targetingof services on people with severe mental health problems. Themajority of service users felt involved in planning their owncare and considered that they had choice in their care and treatmentwhen in the community, but not in hospital. Although all theseusers were formally subject to the CPA, the proportions of usersin the districts believing they had a written care programmeranged between 37 per cent and 60 per cent. Of these, the greatmajority were very positive about their care programmes andfelt that they were being helped to become independent. Theseresults were replicated when 87 per cent of the original samplewas re-interviewed six months later. There were significantdifferences between the four districts and evidence that userspreferred an integrated health and social care service. In addition,a higher proportion of users in inclusive districts were satisfiedcompared to those in targeted districts. Notwithstanding thesepositive findings, there is still considerable room for improvementin relation to the involvement of family carers and the provisionof adequate information about prescribed medication and makingformal complaints.