Nigel Turner's HyperGUIDE to the Mental Health Act

Supervision Registers

Who is Involved

Since April 1994, local Mental Healthcare providers - mainly NHS Trusts - have been required to keep a Supervision Register. Placing someone on a Supervision Register is something which is considered as part of the Care Programme Approach. Although the whole multi-disciplinary team should be involved, the ultimate responsibility for deciding whether someone should be placed on the Supervision Register lies with the consultant psychiatrist responsible for the patient's care. In order to be included on the Register, the person concerned must:

• have a severe mental illness
• be a patient of the specialist psychiatric services
• be (or be liable to be) at significant risk of committing serious violence or suicide, or at significant risk of severe self-neglect in some foreseeable circumstances which might realistically arise.

Purpose

Supervision Registers came about largely as a result of concerns that people whose mental health difficulties could at times lead to violence to others, and/or self-harm/neglect, might nevertheless lose contact with specialist services, particularly if they were mobile and moved from one area to another.

The NHS Executive has stated that the purpose of Supervision Registers is in:

• providing a care plan that aims to reduce the risk and ensuring that the patient's care needs are reviewed regularly and that contact by a key worker is maintained
• providing a point of reference for relevant and authorised health and social services staff to enquire whether individuals under the Care Programme Approach are at risk
• planning for the facilities and resources necessary to meet the needs of this group of patients, and
• identifying those patients who should receive the highest priority for care and active follow up.

Information to be Included

The Supervision Register entry for a particular person should normally include:

• the person's full name, address, date of birth, and other identification information
• information about the person's Mental Health Act status, for example, whether the person is on leave, under guardianship or supervised discharge
• the type of risk, such as serious violence to others, suicide, severe self-neglect, and information about warning indicators, or specific events which might increase the risk
• evidence of previous episodes of violent or self-destructive behaviour, or of severe self-neglect
• the name and contact details of the person's key worker
• the names and contact details of other professionals involved
• details of the care programme:
  
  • date of placing on the Register
  • date of the last review of the care plan and the need for inclusion on the Register
  • date of next review due
  • information about the care programme

Access to Information

A person should normally be informed of the fact that they have been placed on the Supervision Register, and what this means. Occasionally the patient may not be informed immediately, if this information might cause serious harm to his/her health at that particular time. The Register is basically a medical record and is therefore covered by the access arrangements of the Access to Health Records Act 1990, and the provisions of the Data Protection Act 1984.

Access for professional staff to the information on the Register is meant to be on a "need to know" basis. The Mental Healthcare provider may disclose information to other agencies (such as a social services authority) with the patient's consent, or without that consent if the disclosure is in the public interest.

Removal from the Register

Care Programme Approach meetings should be held at least every 6 months and each such meeting should consider whether inclusion on the Register is still appropriate. If the patient (or an advocate for the patient), requests removal from the Register, the consultant psychiatrist, in consultation with the care team, should consider this request and provide the patient with reasons for any decision not to withdraw the person from the Register.

It is appropriate for someone to be removed from the Register if

• there is no longer a significant risk of serious violence, suicide or severe self-neglect, in the view of a review meeting (the consultant psychiatrist should not reach this view in isolation)
• the person moves and the patient's care and records are transferred to a new Mental Healthcare provider in the new area. The new provider should confirm in writing that it has agreed to accept this responsibility, and ideally there should be a joint meeting between staff of the two providers. The new provider will need to review the person's needs and, unless it has clear reasons not to do so, make an entry on its own local Supervision Register for the person who has been transferred.

It is NOT appropriate to remove someone from the Register simply because:

• contact has been lost - the key worker and others must make every effort to trace the person and re-establish contact, for example by speaking to relatives, the GP, local hospitals and other nearby Mental Healthcare providers
• the person has been admitted to hospital - the key worker should remain in contact and be involved in discharge planning
• there are problems in delivering the agreed care plan - in which case the Plan should be reviewed by the team concerned.