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The supervision register: 19 months after its introduction

Guy's and St Thomas's Medical and Dental School, Division of Psychiatry and Psychology, Guy's Hospital, London Bridge, London SE1 9RT

Aims and method To examine whether, 19 months after its introduction, the goals of the supervision register have been met. A matched case-control study of patients on the supervision register and Care Programme Approach was conducted.

Results Cases and controls demonstrated similar socio-demographic characteristics, primary diagnoses and community psychiatric care. The supervision register group were more likely to use concurrent alcohol and/or illicit drugs (P=0.001) or suffer with an accompanying personality disorder (P=0.0001), and were less likely to have experience of a long-term relationship (P=0.003). Nineteen months after registration, the supervision register group were more likely to be violent to others (P=0.002) or involved in serious threatening behaviour to others (P=0.0007). Relapse of mental illness was the only significant predictor of future violence in the supervision register group (P<0.01).

Clinical implications Patients with a history of violence to others were found to be appropriately placed on the supervision register but continued to demonstrate aggressive behaviour after registration, indicating that the goal of the supervision register to prioritise most appropriate care and treatment for this group of patients has not been met.