Implementation of care programme approach in learning disability

It is appalling that services have not all implemented the care programme approach (CPA) for people with learning disabilities and mental health problems (Roy, 2000). This is despite clear guidance regarding this patient group (Department of Health, 1999). Indeed, one meaningful way of promoting empowerment would be to ensure that such people receive the same recognised standard of mental healthcare as everyone else. The CPA audit in people with learning disabilities reported by Ali et al (Psychiatric Bulletin, November 2006, 30, 415–418) is thus welcome. It raises two issues of care coordination.

First, there has also been resistance to CPA implementation by learning disabilities’ psychologists here in South London. However, all professionals need to follow this modern, holistic, systematic, multidisciplinary way of organising mental healthcare. Services for people with learning disabilities are relatively well resourced with psychology staff compared with most generic mental health services. In addition, the lead intervention is frequently the introduction and ongoing review of behavioural management guidelines. Thus psychologists and/or behavioural therapists are often the best placed to become CPA care coordinators for some people with learning disabilities.

Second, Ali et al describe using care coordinators who are not employed by mental health trusts. However, it will always be difficult to monitor CPA properly through the governance systems of primary care trusts or social services departments or non-statutory organisations when none of these has a mental health focus or priority. The CPA is a major reason why mental health services for people with learning disabilities should always be sited within mental health trusts (O’Hara, 2001).