In common with other psychiatric units throughout the land, we have been struggling to come to terms with the Government directives regarding the Care Programme Approach. A great deal of time has been spent attempting to devise a system which is workable and useful but which might leave some time for face-to-face contact with patients; implementing it forces the psychiatrist into a catch–22 situation. If things are seriously wrong for a patient, the psychiatrist could be criticised for not putting somebody on CPA, or criticised for putting them on it but not carrying the process through thoroughly enough. In spite of this, I have participated in the scheme, if only because the consensus would seem to be that it is necessary to have the system in place, mainly as a defensive measure or in the hope of ensuring adequate resources. My overwhelming feeling, however, has been that it has been a time-consuming way of formalising good practice, and that the time spent filling in the forms would be better spent talking to the patients. I have always felt uncomfortable listing needs and solutions with the patient and ‘the team’, because it seemed reductionist, but I thought that this was my idiosyncratic response, and that I should get on with it. Recently, however, there was a near disaster with a patient which served to strengthen my reservations.
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