After seven years of circulars, monitoring, conferences and discussion, frank talking about the CPA may still be welcome, but proposals to CPA coordinators and members of community mental health teams (CMHTs) to revise the procedures implemented by trusts are less likely to be. The previous paper (Burns & Leibowitz) identified a number of difficulties that have accompanied the implementation of the Care Programme Approach, particularly confusion related to care and case management. The CPA was introduced in response to the Spokes Inquiry (Spokes, 1988) as a therapeutic strategy to ensure that a coordinated safety-net of care for people with severe mental illness (SMI) was put in place in every district. Identification of those with SMI means that the approach includes all those accepted by mental health services; those with SMI need a coordinated multidisciplinary response. The CPA Audit Tool developed by the College Research Unit for the National Health Service Executive (NHSE) and disseminated to all districts in 1995/96 may be valuable in reassessing CPA implementation.
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