Implementing the care programme approach in psychotherapeutic settings

Chris Mace is consultant psychotherapist to the South Warwickshire Primary Care Trust (Ashton House, 15 George Street, Leamington Spa, Warwickshire CV31 1ET, UK), where he has been Clinical Manager of the Psychodynamic Psychotherapy Service since 1992. He is also an honorary senior lecturer in psychotherapy at the University of Warwick. His current research interests include clinical assessment for psychotherapy, risk assessment and the analysis of obstacles to care within publicly funded services.

The care programme approach (CPA) should be implemented across all mental health services. However, the specific needs of psychotherapeutic settings were not recognised in the official documentation. The scope for conflict between therapeutic practices and CPA requirements may have increased following revision of CPA guidelines. A recent survey of consultants in psychotherapy confirmed that implementation of CPA remained uneven. The additional time required, threats to confidentiality and a negative impact on the therapeutic relationship were common concerns. Positive effects on assessment procedures and liaison between services were also reported. Practical suggestions for minimising potential negative effects of CPA are given. It is recommended that all services providing psychological therapies develop a written policy for the local implementation of CPA.