Managing Long Term Conditions: The Role of Care Co-ordinators in Mental Health

1. Managing Long Term Conditions:The Role of Care Co-ordinatorsin Mental Health

2. What is CPA? • “CPA is a term describing the process of how mental health services assess your needs, plan ways to meet them and check that they are being met. You should always feel able to ask mental health workers to explain this process to you.” DH Users & Carers information leaflet March 2008

3. CPA is a co-ordinated process

4. Long term conditions in mental health • Serious mental disorders include a wide range of acute and time limited conditions which respond well to modern treatments; • They also include severe and enduring conditions such as long term depression, schizophrenia, self harm, or psychological problems; • long term mental health conditions correlate with heart disease, obesity and diabetes which may go untreated; • People with long term mental health conditions are more likely to be poor, a victim of crime or socially excluded. 

5. How common are mental health problems – the impact on Society & NHS utilisation In acute physical care services Our children Senior citizens The workforce • 1 in 5 under the age of 15 • Only 25% can access care • 50% bullied, leading to: • Depression • Low self-esteem • Suicide • 1: 10 have unrecognised • dyslexia, • dyspraxia • Dementia effects • 5% over 65’s • 10-20% over 80 • 1 in 6 over 65 suffer from depression • Major factors: • Social isolation • Physical ill- health • 30% of >65s in Acute Trust beds have dementia • 50% of people in some long term acute clinics have medically unexplained symptoms • 50% people with irritable bowel syndrome have unrecognised abuse histories • In A/E the prevalence of alcohol-related injury is approx. 24% 1 in 6 adults at any time 1: 10 have depression Suicide is the greatest cause of male deaths < 35 yrs Work related stress affects 1.5 million & 5.6 million work days lost a year

6. Background to CPA • Predates ‘Our NHS, Our Future’ and ‘personalisation’ • 1990 CPA first used to describe a framework to co-ordinate care for severely mentally ill people within secondary services

7. Background to CPA cont. 2008 refocused as an approach to those with more complex characteristics • The named person who co-ordinates delivery of the care plan • A professional able to explain services and interventions to the user and carers • Appointed when service user’s needs are numerous or complex or when a range of services are provided • A role underpinned by values and principles accepted across all MH disciplines

8. Values and Principles(10 essential shared capabilities DH 2005) • Working in partnership • Respecting diversity • Practising ethically • Challenging inequality • Promoting recovery • Identifying needs and strengths • Service user centred care • Making a difference • Promoting safety and positive risk taking • Personal development and learning

9. Who is care co-ordinator? • Multi-disciplinary role (e.g. nurse, social worker, occupational therapist, doctor) • User and Carers have name and contact details of care co-ordinator

10. Care co-ordinator competenciesNational Occupational Standards / Skills for Health • Comprehensive needs assessment (mental health, potential needs, physical health needs, planning care) • Risk assessment and management (risk plan to support daily living, assess risk of abuse, harm to self and others) • Crisis planning and management (work with individual and family during crisis/respond to crisis • Assessing and responding to carer’s needs (work in collaboration, assess carers needs, develop support to carers, empower family) • Care planning and review (co-ordinate and monitor services, plan evaluate interventions) • Transfer of care and discharge (plan transfers and discharge with individuals/facilitate transfers between agencies or services)

11. Training Approach‘CPA Care- coordinator training’ 8 units of learning * (flexibility of delivery): 1. Personalisation, Values and the CPA 2. Refocusing CPA- key themes 3. Role Authority & Responsibilities of Care Co-ordinators 4. Comprehensive Assessment 5. Care Planning 6. Whole Systems Approach 7. Outcomes, evaluation and review of care 8. Transition points in care *risk management is integrated into units

12. National Learning Resource for the Refocused Care Programme Approach Further Information: Andy Betts Care for Clinical and Academic workforce Innovation University of Lincoln abetts@lincoln.ac.uk 01522 837 738

13. Extract from DVD “Making the CPA work for you” DVD and contact: DH March 2008 DH Publications Orderline R-mail: dh@prolog.uk.com www.dh.gov.uk/publications