Psychiatric patients at greatest risk and in greatest need: impact of the supervision register policy

Background: Mental health provider trusts in England were required in 1994 to establish local Supervision Registers of patients at risk. Aims: To identify the factors associated with registration, and obtain clinicians' 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 were a heterogeneous group. For some there was little evidence of risk. In most cases clinicians did not believe registration had improved care. Conclusions: The Supervision Register policy has not resulted in the identification of a well-defined group. Its effectiveness is limited by the lack of operationalised measures of risk.