Psychiatric patients at greatest risk and in greatest need - Impact of theSupervision Register Policy

Background Mental health provider trusts in England were required in 1994 t o establish local Supervision Registers of patients at risk. Aims To identify the factors associated with registration, and obtain clini cians' views on its effectiveness. Method At a random sample of 14 trusts data were collected from case notes. keyworkers and responsible medical officers. Results A sample of 133 registered patients were more disabled and had more extensive histories of violence and self-harm than 126 comparison patients on the upper tier of the Care Programme Approach (CPA). Those registered w ere a heterogeneous group. For some there was little evidence of risk. In m ost cases clinicians did not believe registration had improved care. Conclusions The Supervision Register policy has not resulted in the identif ication of a well-defined group. Its effectiveness is limited by the lack o f operationalised measures of risk.