The Care Programme Approach in learning disability psychiatry

primary care services, phenomenology of depression and ethical issues in learning disability, such as sterilisation and consent. For nearly three decades, closure of large psychi-atric and learning disability hospitals has contin-ued and more people with mental health needs remain in the community. With this continuing decrease in hospital provision, there has been an increased focus on the development of systems of safe care and effective treatment for people with significant mental health problems living in the community. Attempts to make this a central plank of mental health care have been reflected in legislation and guidance produced by the Depart-ment of Health. The Care Programme Approach (CPA) was introduced in 1991 after the publication of HC (90) 23/LASSL (90) 11 and subsequen