Legal & Ethical Issues

Legal & Ethical Issues

Introduction

The following assignment is an analysis of a critical incident that focuses on one aspect of care management. This will be achieved firstly by giving a brief description of the client concerned and the way in which his care is managed, and then by reflecting on practice which took place whilst working within my current placement area. In order to assist with the reflection I have chosen to use Marks-Maran and Rose's (1997) model of reflection (see appendix A). I have spoken to the client and his care co-ordinator regarding the possibility of writing about the planning and delivery of his care. His care co-ordinator, advocating on his behalf, felt this would be OK for the client concerned, I explained to them both that the study would be confidential. In order to maintain confidentiality, to comply with local policies and with the United Kingdom Central Council's (UKCC) (1992) Codes of Conduct, clauses nine and ten, I have referred to the client as David.

David is a 24-year-old gentleman who has recently been admitted to the crisis intervention service in which I am currently placed. David was admitted to the service following reports of destructive and aggressive behaviors towards his environment, himself and others. He has a mild learning disability, challenging behaviour and is diagnosed as having schizophrenia and autism. A consequence of David's behaviors has meant that he is now detained under section 3 of the Mental health Act (1983).

Care Management

Although all of the clients who are admitted to this service have a form of learning disability, a majority of them, like David, also have mental health needs. For this reason David's care is managed using a care plan package that is based on the Care Programme Approach (CPA). This has been called the "cornerstone of the Government's mental health policy." It was introduced in 1991, (Department of Health (DoH) 1991) and was intended to be the basis for the care of people with mental health needs outside hospital. Although in the recent government's document the DoH (1999a) now states that the CPA is not simply "an aftercare arrangement". They go on to emphasise that it is as applicable to service users in residential settings as to those in the community, and assertive inreach is as relevant as assertive outreach as an underpinning principle of the CPA. The NHS Executive (1996) also stress that CPA may be used with people who have learning disabilities.

The CPA has now been integrated with Care Management (NHS Executive 1999, DoH 1999b), which has previously been practised (under the NHS and Community Care Act (1990)) by local authority social services departments whilst they are undertaking their duties of assessing needs and purchasing appropriate services.

The CPA process has four stages:

"IA systematic assessment of the person's healthcare and social care needs

"IThe development of a care plan agreed by all involved, including the person her/himself and any informal carers, as far as this is possible, and addressing the assessed needs

"IIdentifying a care co-ordinator to ...