Care planning and you

What is a care plan?

A care plan is statement of your needs and a written plan on how these needs will be met to support your recovery.

As part of the Care Planning Approach (CPA), you will have a named Care Co-ordinator or named nurse.

You and your Care Co-ordinator will work together to write your care plan. This is the first step in making sure you have choices and are involved in making decisions about your care.

What will my care plan cover?

Your care plan will include:

the problems you are experiencing and your needs;
your goals; and what you will do and what we will do to help you achieve these;
the services and treatment you will receive. This can include advance decisions or statements to be taken into account if you became too unwell to make decisions;

contact details for support.

Your care plan may also include:

ways to improve your physical health; such as stopping smoking or taking more exercise and checks of any medication;
having more contact with other people;
help with benefits or employment.

Support in a crisis

Every care plan should include:

possible early warning signs of a relapse or crisis;

what you can do to help yourself;
how you would like services to respond to enable you to remain in your home
and avoid hospital admission.

Getting involved in your care plan

Recovery outcomes are most successful when care plans are done in partnership with you and others who are supporting you (if appropriate). Your care plan should:

take account of your thoughts and views on how you would like your
care delivered;
recognise your personal qualities and strengths;
record any areas you disagree with;.
be clear and easy to read and understand. If you need your care plan in a different format such as large print or Easy Read, please ask your Care Co-ordinator.

Carers, family and friends

If relatives, family or friends are supporting you, we will encourage them to be involved in your care plan, unless you tell us that you do not want this.

If you feel parts of your care plan should be kept private, please talk to your Care
Co-ordinator.

We will ask you to tell us who to share information with and you will need to sign an Information Sharing Consent Form. This can be reviewed regularly at your request.

Who sees my care plan?

Your care plan is held securely on your electronic record so that all the professionals involved in your care can refer to it. A copy will also be sent to your GP.

Your Care Co-ordinator should give you and your carers (if appropriate) a copy of your care plan. Please ask if this does not happen.

Why is your care plan important?

Having a care plan helps make sure that:

You get the right services at the right time from the right healthcare professionals;

You have choices and are involved in making decisions;
We look at all your needs, not just your mental health needs;
Everyone is clear about your care.

Care plan reviews

A meeting to review your care plan (sometimes called a ‘CPA’ meeting) will take place every six months (or sooner if needed) with you and the people involved in your care.

The purpose is to:

talk about how you are getting on
discuss any new or additional needs you may have
try to resolve any difficulties in meeting your plan and to agree any changes

It is your meeting and it is up to you who else you want to invite - friend, relative or carer. You may want to invite some people for parts of the meeting and this can be arranged.

You can also invite an independent mental health advocate to support you at the meeting.

You should receive an updated copy of your care plan within a week of the meeting.