Objectives: The Care Programme Approach (CPA) is the official framework for care for adults with severe mental health problems in England. Research on interactions in health settings have explored key concepts of patient-centred care, shared decision-making and the biopsychosocial model. Discourse analysis has been used to examine interactions in both health and mental health care. However, research on the CPA has largely been based on service outcome measures and interviews with service providers. This study aimed to explore discursive constructions of service users' difficulties and therapeutic interventions in CPA meetings and documentation in community mental health settings; how potentially different viewpoints are negotiated; and the differences and similarities between the meetings and documentation. Method: Audiorecordings of six CPA meetings and their resultant CPA documents were collected from a Community Mental Health Team and an Early Intervention Service. A discourse analysis at the micro level, using a Discursive Psychology framework, and at the macro level, using a Foucauldian Discourse Analysis framework was conducted. Results: An account of constructions of services users' difficulties, causes and risk factors, care as medicine and care as managing the practicalities of everyday living was produced. Rhetorical devices were used to create consensual explanations of difficulties and decisions about medicine; tensions and disagreements were not recorded in CPA documents. Discourses of a medical model of difficulties were implicit and explicit in both teams, although discourses of a biopsychosocial model were also apparent in the Early Intervention Service. The complexity of participants negotiating discourses about the value of paid employment and discourses of illness were evidenced in all meetings. Conclusions: Discourse analysis provided a useful means to explore CPA meetings and documentation. The primacy of the medical model, even within biopsychosocial accounts, and the goals of shared decision making within a recovery framework are discussed and clinical, policy, and research implications are explored.