Well Worn, Tried and Tested: Every Road has its Bumps!

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Most Useful article in The Approach as awarded by the readership

I have, as a mental health service user consultant been travelling the road for years now with my CPA tucked firmly in my rucksack. It has become somewhat dog–eared, and the effective comprehensive support and care has not always materialised in practice, however, we are none of us perfect and we acknowledge this. I have always believed that CPA is the best way forward not only for recipients of services, but also for any staff involved in the implementation. We are just not approaching this from the right angle, which is so plainly obvious and simple to see (from my perspective) and why this vital factor is often missing. I am able to say this with some authority because I have always adopted my own preferred approach to the implementation process of my CPA. My consultant who was also my Care Co–ordinator was in agreement, this was best practice jointly and effectively carried out.

I have been the recipient of care under Standard CPA... and also Enhanced CPA. However repeatedly, years down the line we are still having the same discussions on “How to Make it Happen” we all know what to do in theory but cannot translate this into practice. Is it perhaps the differences of each person or is it perhaps the service they have? Change is often seen as a challenge and may move forward slowly... we have come to a halt. I feel we have become lost in the forest and now cannot see clearly — nor find our way out. The foundation stones have always been there to build on but we have not effectively engaged fully with the single core element and key to truly unlocking this very powerful fundamental transformation for our mental health practice.

Life not shaped by the event but by the meaning

Our Life is not shaped by the event but by the meaning we attach to it. It is we, the persons for whom CPA was designed to support, we are at the centre, the pivotal point. Assessment and care planning for our treatment and support is individual, unique and different to each and every one of us. It must address our well–being across the board, all aspects of possible need, our life experiences, our personal identity, difficulties and challenges dictates surely that it must come from us... who knows us better than we know ourselves? A balanced view which is written and developed by the person themselves and drawing on their own experiences, understanding and perspective... how they live it.

Being squeezed into a square box!

This will be right for each and every individual, not being squeezed into a square box that we do not fit into because that is what is available on the paper work, nor a label that does not fit either... but a person with a voice. To facilitate good CPA practice we need to use a fair consistent approach that will deliver positive outcomes. Giving a person the right, the opportunity and choice to actually write their own CPA, which can then be discussed with their support team and joint decisions made and agreed to, is equality in action. It is effectively placing equal ownership of the CPA with them enabling a real honest input into their life choices. This is true participation and people would feel more committed to working with their CPA and expressing any concerns arising to Care Co–ordinator and support team if things are going wrong. Instead of what we often see, hear of, the total disengaging from services because it is not really their plan, they were only asked, there was no true involvement, communication or discussion, they just signed it.

A vast chasm between ownership and assuming responsibility

There is a vast chasm between ownership and assuming some of the responsibility for your own CPA... and having it done for you whilst you sit there. The latter is not really effective inclusive working together, and will never achieve the aims of true positive practice. Whilst there are good examples of CPA working and these are applauded and dedicated staff committed to making it work... we still are far from reaching the elusive “We have Made It Happen”. The stepping stone towards positive real empowerment is giving the person who is accessing the team, confidence, self esteem and respect, acknowledging their ownability to contribute and communicate their needs directly, at a level they are comfortable with and understand. This may mean everyone thinking of and taking different innovative approaches for positive engagement... There–in lies the challenge to us all.

A long winding road

It’s taken many different journeys to come this far It has been a long winding road with many twists and turns across the years, and we are still debating how to, what if, when to, why, perhaps, maybe if, is it the type of care provided? Is it the organisational structure? Every conference raises exactly the same questions year in... year out. Is it not time to actually find our way out of the forest and stop trying to re–arrange and fit CPA into the framework that clearly is not working as effectively as it should. We should grasp CPA and turn it round completely and truly approach from a service user perspective putting them at the heart of their care planning, having shared ownership, joint responsibility, real involvement. It’s all about acknowledging the kind of life that we lead, reflecting who we are as an individual, identifying our current and future treatment and support. To each of us this is important it makes a real difference, life is about connecting, listening, sharing and communicating and our CPA must be a truly honest, reflective, work in process encompassed by everyone.

I do not pretend to think this will be easy, it challenges us each to understand the values, strengths and weaknesses from both user and professional perspectives, and calls for complete honesty, transparency and openness. Without this there can be no trust, there perhaps may be barriers to overcome on both sides, however it will hopefully build a stronger foundation for a therapeutic relationship between all involved.

THERE ARE NO IMPOSSIBLE DREAMS, JUST OUR LIMITED PERCEPTION OF WHAT IS POSSIBLE.

Monica Endersby , BA Mental Health Service User Consultant Speaker, Facilitator, Mental health Educator, Accredited Recovery Approach ( WRAP) & Relapse Plans Trainer, Researcher Trainer, CPA, Advance Directive/Statements.