This is something that I have been involved in as part of discharge planning of a service user when there are concerns about them returning to their home/everyday live, and as result of their condition/disruption. The Care Programme Approach (CPA) is a way that services pull together with a coordinated if someone has mental health issues, but also complex needs such as mobility issues that would mean they were unable to return to their own home without adjustments being made. This is available to anyone experiencing mental health problems is entitled to an assessment of their needs with a mental healthcare professional, and to have a care plan that’s regularly reviewed by that professional. (Rethink, 2015).

A service user would be offered CPA support:
• Diagnosed as having a severe mental disorder and there may be a risk of suicide, self-harm, or harm to others.
• If there is a tendency to neglect oneself and don’t take treatment regularly.
• Are vulnerable; this could be for various reasons, such as physical or emotional abuse, financial difficulties because of mental illness or cognitive impairment
• Have misused drugs or alcohol
• Have learning disabilities
• Rely significantly on the support of a carer, or have your own caring responsibilities
• Have recently been detained under the Mental Health Act
• Have parenting responsibilities
• Have a history of violence or self-harm. (NHS choices, 2015).

Through my own experience this has been in the case of:
Mental health example:
• This has been in terms of housing, whether the service user has a home to return to e.g. homeless, or whether there home was a result of a decline/trauma that resulted in them being admitted such as isolation (a risk of suicide, self-harm) or fear of violence.
• ‘Safe guarding’ also harm to others to family member such as ‘domestic violence’, or for instance financial abuse.
• But also those around the service user in the social location that would promote such things as drug alcohol abuse and a result a slip in their condition, that this environment would be negative to there recovery.
• I there issues of neglect/carer required, then the type of accommodation that would be suitable, e.g. warden assisted, but also with the CPA as to whether whilst the eventual goal may be for a service user to live independently, then an interim such as a vocational/support accommodation in the community to prepare to that eventual goal.
• As a result this has resulted in delays in discharging service users, but one that I understand is to get things right so that it is long lasting, and for a successful discharge, than one where the service user may be re-admitted.

Physical health example:
• Whilst there would be many of the safeguarding issues, there may also be in terms of housing, whether the service users home may be a risk, e.g. stairs if mobility issues. Or alternative accommodation such as if they service user is elderly then a residential care home, then with the OT it would be to assess whether with adjustment that the service user could stay in their home.
• Whether a carer would be required, or if the level of support required would be to a point where it would be no longer viable or the service user would have the same quality of life, such as a ‘micro environment’ where the service user would live in one room or just on one floor, and everything is easily to hand to attend to self care/activities of daily living. (ADL).
• In these cases I have seen the OT as the real advocate for the service user so that they are able to stay in their own with reasonable adjustments made so that they can still retain that quality of life that won’t inhibit there health and well-being.

References
NHS Choices. (2015) Care Programme Approach (CPA) http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/care-programme-approach.aspx

Rethink. (2015)The Care Programme Approach fact-sheet providing further information about the Care Programme Approach (PDF, 493kb).