An exploration of the factors influencing the local implementation of the Care Programme Approach in the provision of mental health services for clients with learning disabilities

Introduced by the UK Department of Health in 1990, the Care Programme Approach (CPA) was intended to be a framework through which health and social services could provide integrated care for people with mental health problems. Its purpose was to ensure that services had systematic arrangements to provide psychiatric, health and social care with arrangements in place for the ongoing provision and review of that care. Care coordinators, spanning service boundaries, were expected to oversee that process. In order to ensure that services could work together, the Health Act (1999) enabled local services to pool budgets, lead commissioning and integrate provision.

Despite repeated government efforts to support the policy, its implementation faced many problems. Alongside issues with resistance from professionals at a local level, there were also issues at the strategic level associated with the actual integration process.

Second to this, the policy did not acknowledge people who had mental health problems and a concurrent learning disability (dual diagnosis) until 10 years after the policy was introduced and thus these clients did not receive care through CPA as expected. With so little known about the strategic level factors affecting implementation or the actual implementation process for this particular client group, this thesis aimed to explore the factors shaping the local implementation of CPA for these clients from a strategic-level perspective.