The Care Program Approach [CPA] envisages that patients with serious mental illness who are deemed to be at risk [of self harm, harm to others, or serious deterioration of their condition] should have an appropriate assessment of needs, an appropriate care plan and should have an allocated care co-ordinator to implement the plan.

We investigated whether patients with Bipolar Disorder, Schizophrenia and Depression, who had recorded risk factors did indeed have an allocated care co-ordinator in a typical English Community Mental Health Team [CMHT]. This issue is of importance in describing ‘Treatment as Usual’ in a CMHT when comparing it to newer forms of management, such as assertive outreach teams.

We used a database held by a CMHT in order to assess whether all patients with the above diagnoses did indeed have an appointed care coordinator.

The results show poor correlation between diagnosis, presence of risk factors, and the appointment of a care coordinator. Interestingly, patients with bipolar disorder appeared more likely to have a care coordinator appointed than patients with schizophrenia. Patients with depression were least likely to have a care coordinator appointed.

Lack of resources in the CMHT may account for the results. Another issue may be that, with treatment, patients may become less risk prone, but the work of the care coordinator may not be completed, and so the care coordinator may continue to be involved, thus being unable to move to other more needy patients in the team.