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Psychiatric patients at greatest risk and in greatest need

Impact of the Supervision Register Policy

PRiSM, Institute of Psychiatry London

Correspondence: Jonathan Bindman, Section of Community Psychiatry (PRiSM), Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

Declaration of interest This study was funded by a grant from the Department of Health. The views expressed are those of the authors and not necessarily those of the Department of Health.

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.

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