Memorandum of Procedure on Restricted Patients

An essential reference document for those who are involved in the management and care of patients subject to a compulsion order with restriction order.


Background to CPA

4.1 The Care Programme Approach (" CPA") was developed originally for use at local level in Scotland for people with severe and enduring mental illness in 1996 via Scottish Office Circular SWSG 16/9. Unlike in England, where CPA was mandatory, this circular simply recommended CPA for use in Scotland.

4.2 In 2006, the Forensic Network was asked to carry out a survey of current practice in respect of implementation of the CPA across forensic services in Scotland. Their remit was to review and revise the CPA Guidance to ensure that the protection of the public was at the core of the decision making in respect of restricted patients' rehabilitation in light of the new Management of Offenders etc (Scotland) Act 2005 ("the 2005 Act") and the introduction of Multi-Agency Public Protection Arrangements (" MAPPA"), and to establish joint arrangements for effective risk management. The Network subsequently developed proposals and recommendations for future action on behalf of the Scottish Government publishing a Report on their Review of CPA Guidance for Restricted Patients in Scotland in December 2006 40. The Scottish Government, taking account of the responses to the consultation exercise, accepted and endorsed the recommendations made in the consultation report. The guidance with respect to the key components of the CPA as outlined in section 8 of the CPA Consultation Report was adopted by the Scottish Ministers as policy 41. A prominent feature of enhanced CPA is ensuring consistency across Scotland.

4.3 The proposals for CPA were developed in the context of the new duties on NHS Boards established under the 2005 Act which gives a statutory basis for the MAPPA. By complying with the recommendations in the CPA Consultation Report, NHS Boards will be able to meet many of their obligations under MAPPA in those cases where they are the responsible authority.

4.4 The CPA has been adopted as the mechanism for regular review for all patients subject to Compulsion Order with Restriction Order ( CORO), Hospital Direction ( HD), Transfer for Treatment Direction (" TTD") and Interim Compulsion Order ( ICO). Under Delivering for Mental Health42 and the MAPPA guidance all restricted patients from 30 April 2008 must be being managed under the new CPA arrangements.

4.5 In May 2010, the Forensic Network produced updated guidance on the use of CPA. The full report can be accessed on the Forensic Network website. The updated guidance incorporates child protection, protection of adults at risk of harm, risk factors relating to driving, suspension of detention forms, risk management traffic lights good practice guidance (with examples), identifying new information within objectives and new CPAdocumentation including a template for pre- CPA discussion.

Purpose and aims of CPA

4.6 The purpose and aims of CPA today are:

  • to ensure that patients with a mental disorder associated with complex health and social care needs receive on-going care support and supervision throughout their detention in hospital and rehabilitation into the community
  • to ensure structured support for those most in need, or most at risk to themselves or others
  • to ensure that there is effective multi disciplinary agency collaboration
  • to ensure that patients and their families and carers are involved as far as possible with care planning decisions and arrangements
  • to enable systematic arrangements for the assessment and management of health and social care needs
  • to ensure the appointment of a lead care co-ordinator to monitor and co-ordinate care arrangements
  • to ensure that the policy is compatible across Scotland.

Implementing CPA

4.7 The Scottish Government CEL 13 (2007)43 provides guidance on the implementation of CPA, the roles of individuals and templates of the documentation which supports the CPA process:

  • CPA is the appropriate tool for all restricted patients
  • an initial CPA meeting should be held approximately 4 - 10 weeks after admission to hospital and a review meeting should be held at a frequency of at least every 6 months.
  • more frequent meetings will be necessary at transitional points and where there are changes in circumstances which need to be considered particularly those that influence risk.


4.8 As outlined in Chapter 3, the updated CPA documentation will be used to record risk assessment, multi-disciplinary reports and management plans as well as the ongoing care and treatment of the patient. The traffic lights system is an integral part of the CPA documentation and clearly highlights risks, relapse signs and crisis planning. Examples of Risk Management traffic lights for all levels of security, including in the community, is contained in Annex H

4.9 The CPA documentation will also be used in place of the previous Memorandum's Annex B3 to provide the risk management information necessary to support requests for escorted and unescorted suspension of detention " SUS". For more details see Chapter 8 and the SUSplan template.

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