Psychiatric patients at greatest risk and in greatest need. Impact of the Supervision Register Policy.

Abstract

Mental health provider trusts in England were required in 1994 to establish local Supervision Registers of patients at risk. To identify the factors associated with registration, and obtain clinicians' views on its effectiveness. At a random sample of 14 trusts data were collected from case notes, key workers and responsible medical officers. 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. The Supervision Register policy has not resulted in the identification of a well-defined group. Its effectiveness is limited by the lack of operationalized measures of risk.