Care Programme Approach (CPA) Documentation for Psychologists (UK)

What Is the Care Programme Approach?

The Care Programme Approach (CPA) is a framework used in NHS mental health services in England to coordinate care for people with complex mental health needs. Introduced in 1991 and refined in 2008 under "Refocusing the Care Programme Approach," CPA provides a structured process for assessing needs, developing care plans, allocating a care coordinator, and reviewing care at regular intervals.

CPA applies to patients who have complex, multiple needs that require input from several professionals or agencies — for example, a person with treatment-resistant psychosis who requires input from a psychiatrist, psychologist, community psychiatric nurse, social worker, and supported housing provider. The framework ensures that these multiple inputs are coordinated rather than fragmented, that the patient has a single named point of contact (the care coordinator), and that care is regularly reviewed in a formal multi-professional meeting.

For psychologists working in community mental health teams (CMHTs), crisis teams, early intervention in psychosis services, or specialist personality disorder services, CPA is a routine part of clinical practice. Your psychological input — formulation, therapy, risk assessment — sits within a broader care package that is documented and reviewed through the CPA framework. Understanding how to contribute effectively to CPA documentation is essential for integrated care delivery.

While some NHS trusts are transitioning to newer care coordination models under the community mental health framework, the principles of CPA — coordinated assessment, documented care planning, named professional responsibility, and regular review — remain central to good practice for complex cases.

When You Need It

You will engage with CPA documentation in these situations:

• When a patient on your caseload is under CPA — you are expected to contribute psychological updates to CPA reviews and maintain clinical records that inform the care plan
• When you are the care coordinator — you are responsible for the care plan, review meetings, and coordination of all services involved in the patient's care
• CPA review meetings — formal multi-professional reviews where the care plan is evaluated and updated
• Care plan development — contributing psychological formulation and treatment goals to the integrated care plan
• Crisis and contingency planning — contributing to the development of crisis plans that document warning signs, coping strategies, and emergency contacts
• Discharge from CPA — when a patient's needs have reduced to the point where CPA-level coordination is no longer required, and they can step down to standard care
• Transitions — when a patient is transferring between teams (e.g., from inpatient to community, or from one CMHT to another), CPA documentation facilitates continuity

Key Components / Requirements

CPA Care Plan

The CPA care plan is the central document. It should include:

• Patient details — name, NHS number, date of birth, GP, next of kin, and any communication needs
• Care coordinator details — name, role, contact information, and team
• Assessed needs — a comprehensive assessment of the patient's mental health, physical health, social, housing, financial, occupational, and relational needs
• Goals — collaboratively agreed goals that the patient is working toward, written in the patient's own words where possible
• Interventions and responsible professionals — what each professional or service is providing, how often, and what they are aiming to achieve
• Risk assessment and management plan — current risk formulation, identified risk factors and protective factors, and the management plan
• Crisis and contingency plan — what to do if the patient's mental health deteriorates, including early warning signs, coping strategies, who to contact, and crisis service details
• Medication — current medication, prescriber, and any medication-related monitoring requirements
• Review date — the date of the next CPA review
• Patient and carer involvement — documentation that the patient (and carer, where relevant) has been involved in care plan development and has received a copy

Psychologist's Contribution to the Care Plan

As the treating psychologist, your specific contributions to the care plan include:

Psychological formulation: A concise formulation that explains the patient's difficulties in psychological terms — predisposing factors, precipitating factors, perpetuating factors, and protective factors. This formulation should be accessible to the whole team, not just psychologists.

Psychological treatment plan: What therapy you are providing, the modality, the frequency, the goals of therapy, and the expected duration. This should align with the overall care plan goals.

Outcome measures: Current scores on relevant standardised measures (e.g., CORE-OM, PHQ-9, HONOS, BPRS) and comparison with previous scores.

Risk observations from therapy: Any risk information that has emerged in therapy sessions — disclosures of suicidal ideation, self-harm, substance use, or safeguarding concerns. This information must be shared with the care coordinator and documented appropriately.

CPA Review Documentation

CPA reviews are formal meetings that bring together the patient, their care coordinator, and all involved professionals. The review documentation should include:

• Attendees — who was present and who sent apologies (with any written contributions from absent professionals)
• Review of each care plan area — progress against goals, changes in need, and any new issues
• Updated risk assessment — has risk changed since the last review? Are new risk factors present? Have protective factors changed?
• Decisions made — changes to the care plan, new referrals, changes in medication, changes in professional involvement
• Actions — specific tasks allocated to specific professionals with timescales
• Patient and carer views — documented input from the patient and their carer about what is working, what is not, and what they want to change
• Next review date

Crisis and Contingency Plan

Every CPA patient should have a crisis and contingency plan that is developed collaboratively with the patient and shared with all relevant professionals. As a psychologist, you contribute to this plan by identifying psychological early warning signs (e.g., withdrawal from activities, increased rumination, paranoid thinking), psychological coping strategies the patient has developed in therapy, and any therapy-specific information relevant to crisis management (e.g., DBT skills the patient can use, grounding techniques for dissociation).

How to Write It

Step 1: Prepare a written update before the CPA review. Even if you will attend the meeting in person, prepare a concise written summary of your psychological input since the last review. This ensures your contribution is documented accurately even if the person writing the review minutes summarises it differently.

Step 2: Frame your contribution for a multidisciplinary audience. Your CPA update should be understandable to the whole team — psychiatrists, nurses, social workers, support workers, and the patient. Avoid unexplained psychological jargon. Translate your formulation into accessible language and describe therapy progress in concrete, behavioural terms.

Step 3: Include outcome measure data. Quantitative data strengthens your contribution and allows the team to track progress objectively. Report current scores, comparison with previous scores, and whether reliable change has been achieved.

Step 4: Address risk from a psychological perspective. As a psychologist, you have unique insights into the patient's risk — you understand the psychological mechanisms that drive risk behaviour, the interpersonal triggers, and the internal experiences that precede crises. Contribute this understanding to the team's risk formulation.

Step 5: Make clear recommendations. State explicitly what you recommend — continuing therapy at the current frequency, increasing or decreasing frequency, changing the treatment focus, or planning for ending. Provide the clinical rationale for your recommendation.

Step 6: Contribute to the crisis plan. Ensure the crisis plan reflects the psychological skills and strategies the patient has developed in therapy. If the patient has learned DBT distress tolerance skills, grounding techniques, or cognitive coping strategies, these should be named in the crisis plan so that crisis workers can prompt the patient to use them.

Common Mistakes

• Not providing a written contribution. If you attend the review but do not provide a written update, your input depends on how accurately someone else captures it in the minutes. Submit a written summary that can be filed in the patient's record.
• Writing an update that only a psychologist would understand. CPA is a multidisciplinary framework. If your update references "schema modes" or "mentalisation capacity" without explanation, the CPN, social worker, and patient will not benefit from your contribution.
• Not attending CPA reviews. Psychology input is valuable in CPA reviews, and absence means the psychological perspective is not represented in care planning decisions. If you cannot attend, provide a comprehensive written update and ensure the care coordinator receives it before the meeting.
• Failing to share risk information with the care coordinator. If a patient discloses new risk information in a therapy session (suicidal ideation, self-harm, substance use, safeguarding concerns), this must be communicated to the care coordinator — not held in the therapy room until the next CPA review. Timely risk communication is a professional obligation.
• Not involving the patient in care plan development. CPA is built on the principle of patient involvement. The patient should be present at the review (unless there are exceptional reasons otherwise), should have input into their care plan goals, and should receive a copy of the updated care plan.
• Treating CPA documentation as separate from clinical work. CPA documentation is not administrative overhead — it is the clinical framework within which your therapy sits. Your therapy goals should align with the CPA care plan goals, and your therapy progress should be reflected in care plan updates.