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The care programme approach (CPA) is an important part of supporting people with mental health problems in the community and has been applied with variable success in services for people with learning disabilities. Investigation into service users' understanding of the CPA has been limited. We employed multiple methodologies to explore what service users with learning disabilities and additional mental health problems thought about the CPA process, and what their understanding of it was. We used the findings to work with other professionals to adapt the meetings in a way that was accessible and inclusive. We included this work in the service communication plan and produced guidance for care co‐ordinators and materials to be used at the meetings. The guidance and materials can be used by any service and will be available online.

The Care Programme Approach (CPA) is the fundamental framework for supporting the care and treatment of individuals with severe and complex mental health needs. National consultations with stakeholders (Department of Health, 2006) identified a lack of consistency in the implementation of the CPA across England, informed fresh guidance (Department of Health, 2008a) and highlighted the need for a valid and flexible training initiative to support the workforce in this important aspect of their practice. In response, a partnership team was commissioned by the Department of Health to design and disseminate such a learning resource. This paper details the first impressions of this resource from those who requested the materials and subsequently responded with an online evaluation questionnaire (n=27).These early responses demonstrate that the CPA learning resource is viewed by respondents as flexible, easy‐to‐use and comprehensive. In addition, DVD narratives of professionals, service users and carers' experiences of CPA in adult mental health services were identified as valuable elements of the resource as they assist trainers in the illustration of critical themes. Further results explore its utility in the training environment and highlight flexibility of delivery as an important feature. This enables the resource to be integrated with existing training materials or to guide the development of new training initiatives. As further evaluations are collected and analysed, they will feed into a process of incremental improvement of the learning package to ensure that it meets the requirements of the multidisciplinary workforce.

In the context of public concern about homicides committed by mentally ill people, the assessment and management of risk has become a central feature of national mental health policy and practice. This article reports the increasing profile given to the assessment and management of risk in national guidance on the Care Programme Approach (CPA). It goes on to describe findings from a two‐phase qualitative study to evaluate the integration of risk assessment procedures within the framework of the CPA process and the development of a risk assessment strategy by staff at Redford Lodge Hospital, an independent sector provider of medium secure and forensic rehabilitation psychiatric services.The evaluation demonstrated that Redford Lodge has successfully integrated risk assessment within the CPA process and has developed tools that offer a basis for guiding interventions while the service user is detained in hospital and to inform future strategies for supporting them in the community.

National directives in the UK aim to enhance community provision for mentally ill people. One of these initiatives, the Care Programme Approach (CPA) requires health and social services to develop a needs‐led approach; care plans for discharged patients; co‐ordinated “packages” of health and social care and information systems. A survey conducted in the North Western Regional Health Authority area confirms many of the findings of recent work and raises other issues for health and social services managers. These include the need to: recognize and alter bad clinical‐organizational practices; develop assessment and priority rating systems which combine health and social care variables; implement relevant and accessible information systems; and develop adequate, standardized outcome measures for mental health services.

Increasingly mental health services are attempting to become recovery focused which demands changing the nature of day-to-day interactions and the quality of the experience in services. Care planning is the daily work of mental health services and within this context, care planning that enhances both the experience and the outcomes of a person's recovery is a key element for effective services. However, care plans, the care planning process and the Care Programme Approach (CPA) continue to pose a challenge for services. The purpose of this paper is to discuss these issues.

Conceptual paper.

Within recovery focused services a care plan becomes the driving force, or action plan, behind a person's recovery journey and is focused on their individual needs, strengths, aspirations and personal goals. If involving people directly in the development of their care plan is critical to creating better outcomes then supporting self-management, shared decision making and coproduction all underpin the care planning process. Based on the evidence of people's experience of care plans and the care planning process it is time to seriously debate our current conceptualisation and approach to care planning and the future of the CPA.

The paper describes aspects of the current situation with regard to the effectiveness of care planning in supporting a person's recovery. The paper raises some important questions.

The implementation of the Care Programme Approach (CPA) in English mental health services has been slow to proceed despite general support, both in England and in other countries, of its principles of good practice. This study set out to evaluate the implementation of the CPA directly from patients’ experience using the “Your Treatment and Care” assessment tool. The results of a survey of 503 patients across five NHS Trusts in England showed that many patients did not have a copy of their care plan and had not been involved in the care planning procedure. Many reported shortcomings in their experience of their key worker and their psychiatrist. However, there was substantial variation in experience across services. “Your Treatment and Care” showed good internal reliability, was acceptable to users, and appeared to be able to access actual experiences better than a traditional “satisfaction” item. It appears to be very useful as a benchmarking tool and is now being used in services across the UK, the USA and Australia.

This case study focuses on a young man with severe intellectual disability and autism who engaged in high‐frequency self‐injurious behaviour. Permission to publish this article was given by the individual's mother. The case study offers a review of the input from the local Learning Disabilities Team, particularly from the behaviour support service. The input concentrated on co‐ordination of care, as part of the care programme approach. The care programme approach (CPA) was introduced by the Department of Health in 1990 to provide a framework for effective mental health care for people with severe mental health problems.

The purpose of this paper is to present an audit which assessed compliance in documentation of crisis and contingency plans in the electronic Care Programme Approach (CPA) for working age adult patients discharged from an in‐patient setting.

Two explicit and evidence‐based standards were audited and a full audit cycle was completed. The electronic CPA documentation for all discharges from the adult in‐patient beds of the Trust June 2007 formed the sample for Cycle 1 and the same from June 2008 formed the sample for Cycle 2. Data were obtained from the local electronic database.

The paper finds that the rate of electronic CPA documentation increased over time, as did the crisis and contingency plan documentation within those CPA documents. Although the electronic CPA documentation improved from 33 per cent in June 2007 to 56 per cent in June 2008 (χ² 7.2, df 1, p < 0.01) with a significant improvement on most items measured, they were still far from achieving 100 per cent standards.

Clear guidance making the electronic CPA documentation mandatory so that it can be easily accessed out of hours in a crisis situation would be welcome. It is an important step in reducing the 90‐day re‐admission rates to in‐patient units in psychiatry.

The paper is the first of its kind and demonstrates that dissemination and re‐audit aimed at better electronic documentation are needed to achieve high standards of clinical practice.

This study evaluated the treatment and care received in terms of the care programme approach (CPA) framework within a local specialist mental health community team. A survey method was used to ascertain user experiences (31 respondents), using a brief questionnaire about their treatment and care. The results demonstrated that some clients did not perceive the CPA to be fully implemented. Specifically, clients revealed that they would like more information to be given to them and they did not indicate a full involvement in their care‐planning processes. However, the results pointed to mainly positive perceptions of the professionals involved in client treatment and care. The discussion highlights the similarity of these findings to previous research as well as reviewing the methodological limitations of this study.

The purpose of this paper is to conclude a two-part review of past and current approaches to meeting the more “complex” needs of individuals in the UK context. It explores the dilemmas of commissioning, the development of personalisation approaches in funding or care planning mechanisms, the need to address power relations and lessons from the introduction of the role of a “lead professional” in the Care Programme Approach (CPA), concluding with the development of more systemic approaches at locality level.

This, being the second of two papers, extends the historical narrative approach of Part 1 to the analysis of the term “complex needs” and its role in contemporary service delivery.

The first responsibility of services has been to find ways to engage these more “at risk” individuals and their needs more effectively; and innovation and guidance on this is valuable. But the paper also needs to address the nature of the net itself, that lets so many through. Reliance on individuating mechanisms of service delivery to respond to individual complexity may be less effective in tackling complex needs, unless accompanied by more effective collective representation, and systemic change.

This overview paper brings together themes that are more commonly treated in isolation; in addition, there is hitherto unpublished material on the CPA, and illustration with examples of contemporary developments.