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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.

De‐institutionalisation and the closure of long‐stay hospitals brought about an increased focus on the development of alternative systems for the safe and effective treatment of people with mental health problems. One result of this focus was the introduction of the care programme approach or CPA (DoH, 1989; 1990a; 1990b). The main elements of the CPA are systematic arrangements for assessing the health and social needs of people accepted into mental health services, formulation of a care plan which identifies all health and social care needs, and appointment of a care co‐ordinator to keep in close touch with the patient and to monitor care, regular review, and, if necessary, agreed changes to the care plan.Though the CPA was originally seen as a mechanism to ensure proper aftercare for those discharged from hospitals, the Government later made it clear that it should be seen as a framework for the delivery of mental health care (DoH, 1998). All health authorities are now required to implement it for people with mental health needs referred to specialist psychiatric services.

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.

This paper aims to describe how a patient centred recovery approach was implemented in a secure learning disabilities service.

There are no specific tools for measuring recovery in a secure learning disabilities service. The Recovery Star; a measure of individual recovery was adopted for use among the patients. Staff underwent training on the use of the Recovery Star tool after which a multidisciplinary steering group made some modifications to the tool. Training was cascaded to staff throughout the service and use of the Recovery Star tool was embedded in the care programme approach process.

It was found that implementing a recovery approach with the Recovery Star tool was a beneficial process for the service but that services will require a whole systems approach to implementing recovery. Key workers working with patients thought that the structure of the Recovery Star tool opened up avenues for discussing topics covered in the domains of the Recovery Star tool which may otherwise have not been discussed as fully.

The availability of a tool, integrated into existing service processes, e.g. care programme approach and accompanied by a systems approach, equips patients and staff for articulating and measuring the recovery journey.

The paper shows that the Recovery Star tool, embedded in a care programme approach process, equips patients and staff for measuring the recovery journey.

The purpose of this paper is to describe a study which investigated the diverse needs of multiple stakeholders in an adapted sex offender treatment programme (ASOTP) and then evaluated a pilot programme set up to respond to the identified needs efficiently and effectively. The paper reports on an innovative approach to delivering ASOTP in secure learning disability services. It aims to address many of the criticisms and concerns of conventional closed format programmes, particular in the climate of value for money and payment by results.

The multiple views of stakeholders were identified by means of questionnaires and semi‐structured interviews in order to ascertain the key issues necessitating change. Stakeholders included purchasers of Partnerships in Care Learning Disability Services (PiC LDS), referred clients, internal and external clinicians involved in their care, group facilitators and, in some cases, clients' families or advocates. A rolling format ASOTP (based on the content of the Prison and Probation Service ASOTP) was designed and piloted to address highlighted needs, including time frames for the commencement and completion of treatment.

Initial feedback obtained by means of structured interviews and discussions with all stakeholders has been positive. In particular, participants have shown an increase in motivation, knowledge, and, unexpectedly, enhanced levels of risk disclosure. Facilitators have reported increased satisfaction and decreased stress levels. These findings are tentative in light of the small numbers involved and the absence of a randomised control trial.

This study has a number of implications for future research in terms of improving treatment effectiveness by means of increasing knowledge retention and enhancing risk disclosure, as well as a reduction in facilitator burnout.

The programme was tailored to respond to individual treatment needs within a group setting whilst ensuring programme integrity and effective risk management within a forensic learning disability service.

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.

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.

The UK Government has been planning changes to mental health legislation for at least eight years. On 23 March 2006, the Department of Health announced that many of these plans would proceed ‐ although through amendments to the 1983 Mental Health Act rather than a substantive Bill. These proposed reforms are significant but controversial. This paper sets out some of the reasons for welcoming the proposed changes. It is argued that the proposals to replace the responsible medical officer with a clinical supervisor are in keeping with best quality mental health care, and allow for proper multidisciplinary practice. Such an approach explicitly permits proper use of the skills and competencies of the workforce ‐ including psychologists. A second controversial aspect of the proposed reforms ‐ supervised community treatment orders, permitting compulsory care outside of hospitals ‐ represent not a violation of human rights, but a specific defence of ‘Article 8’ rights to protection of family and personal life. Finally, it is argued that the proposed amendments are important because mental health legislation dominates mental health care and the present 1983 Mental Health Act inappropriately consolidates the status of the medical model and the role of the responsible medical officer (and hence psychiatry). It is argued that the proposed changes are imperfect; in particular they lack inclusion of an ‘impaired judgement’ criterion, but it is suggested that necessary role and service redesign needs such amendments to allow the new ways of working programme to ‘bite’.

The Forensic Mental Health Services Managed Care Network is described, including the School of Forensic Mental Health. The purpose of this paper is to outline background, it details successes and challenges, focuses on links to clinical practice for Learning Disabilities (LD) service development, describes education and training, multi-disciplinary and multi-agency working and quality improvement. Findings from a small scale brief educational study undertaken in the high-secure service are included as an example of good practice.

Specific features relating to LD are highlighted. Comparisons are made with other managed clinical and managed care networks.

The Forensic Network has evolved over time. It has played a crucial role in shaping Scotland’s approach to Forensic Mental Health and LD. Central to its success is active involvement of key stakeholders, a multi-agency approach and collaborative working practice. Future plans include formal evaluation of impact.

This paper offers an interesting perspective from a forensic mental health managed care network; the existing literature is limited.