The Department of Health and the Royal College of Psychiatrists do not see eye to eye over the introduction of supervision registers for patients in the community who are judged to be at risk. In a recent exchange of correspondence the college expressed “strong concerns” about guidelines issued by the department for the introduction of the register on 1 October. Further discussions are planned, but the differences will not easily be resolved.

The issue is much more than a little local difficulty between psychiatrists and the Department of Health; its resolution will be important for all mental health profesionals and for purchasers of psychiatric services. The college is concerned that the criteria for including patients on supervison registers are too broad and about the substantial costs of setting up and servicing the registers. It is also worried about the unclear arragements for withdrawing patients from a register once they have been placed on it and the implications for patients' civil liberties-and about the legal position facing clinician and trusts in the event of a serious assault or suicide of a patient.

The Department of Health disagrees that concern is justified. The secretary of state denies that the criteria for inclusion are too broad, refuses to accept that the introduction of the registers implies the need for any new services requiring additional expenditure, and asserts that the proposed conditions for removing patients from the register are perfectly clear. She has avoided any detailed discussion of the college's concern about civil liberties and on the legal position has asserted that the introduction …