The Care Programme Approach: time for frank talking

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Abstract
The Care Programme Approach (CPA) was introduced as a cornerstone of the Government's mental health policy in 1992 (Kingdon, 1994). It was meant to clarify the complex issues surrounding the coordination of care for the severely mentally ill and to promote interprofessional communication and effective targeting of resources by community mental health teams (CMHTs). The Ritchie report into the care of Christopher Clunis (Ritchie, 1994) underlined the need for clarity about who has overall responsibility for coordination and review of the progress of care – the key worker. The report makes a compelling case for a clearly documented care plan with identified problems, therapeutic goals and an unambiguous statement of who is responsible for what and when. How, then, could this virtuous proposal generate conflict and bad feeling? And why is there relatively little debate about it in the professional press?