The implementation of the Care Programme Approach for service users with a learning disability. Building Bridges to the same Old Horizons?

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Accessible summary

What is known on the subject?

What does this article add to existing knowledge?

What are the implications for practice?


The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership.


This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis.


A single case study approach was undertaken. Data were collected through interview (n = 26), documentary analysis (n = 64), steering group observation (n = 3) and the Partnership Assessment Tool (n = 26). Data were analysed using the Framework Approach.


The CPA was only effectively implemented for people who were deemed to present with a high level of risk.


The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery.

Implications for practice:

Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users.

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