Published: 18/08/2005, Volume II5, No. 5969 Page 27

Fifteen years after its introduction, the care programme approach - a system of assessment, care planning and review - is still to be implemented effectively by many mental health teams.

Back On Track? , the latest in a series of collaborative reports from the Mental Health Act Commission and the Sainsbury Centre for Mental Health, says that patients sectioned more than once in a three-year period do not receive the co-ordinated discharge and after-care to which they are entitled. This contributes to what the report describes as a continuing 'revolving door' effect.

Research was conducted during visits to 119 wards with case-note studies supported by interviews with 151 service users.

It is not all bad news. Newcastle, North Tyneside and Northumberland Mental Health trust and Avon and Wiltshire Mental Health Partnership trust are both cited for accessible and well-ordered paperwork. Pennine Care trust received multiple commendations in a number of areas, including its communications work. Liaison work at Birmingham and Solihull mental health trust has also been recognised.

But the report discloses many instances of trusts failing on the basics.

Symptomatic of what it describes as a 'continued discrimination' against black and minority ethnic patients is the failure to adequately assess different cultural and spiritual needs.

Co-ordinated information sharing is also found wanting. The concept of expert service-users is undermined by failures in consultation. Only one in three care plans had been signed by the service user.

The report includes a list of 18 recommendations and a CPA brief audit tool. It also stresses the importance of legislative documents and reports.

Among these are the national service framework for mental health, the Mental Health Act (revised 1999) code of practice and last year's Blofeld inquiry in to institutional racism.

While the Sainsbury Centre's Acute Care 2004 report recognised the success of crisis teams in keeping all but the most acutely ill out of hospital, Back on Track? suggests these teams and their inpatient services colleagues would enjoy even greater success if the co-ordination of the CPA was pursued with more rigour.

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