With the possible exception of the proposed supervised discharge, the supervision register is the most controversial current government initiative within the mental health field. This paper presents both the guidance issued by the NHS Executive and the concerns that the psychiatric profession has expressed. Time will tell whether the supervision register turns out to be a visionary policy that successfully allays public concerns over community care or an example of a bureaucratic response to an issue of inadequate resources.

In this article, the Director of the NHS Health Advisory Service describes the task which he was given upon appointment and the new roles of the HAS. A senior registrar in forensic psychiatry illuminates one of its new roles by describing his attachment.

Compulsory treatment in the community has engendered considerable differences in opinion, and the recent rejection of a supervision order by a Parliamentary Committee. The arguments were recently debated, at a Section meeting of the College. More detailed research and a wider discussion within the College, and between the College and other interested parties, is needed. Refining these issues, whatever the legislative outcomes, should lead to improvements in community care.

Mental Illness Specific Grant was made available to local authorities for the care of people with severe mental illness, as part of care in the community. Although only a small sum of money it has had the effect of giving the newly created community care planning system a boost start. It has enabled professionals from all agencies to see tangible benefits from collaborative working. MISG is time limited but has already shown that health and social services can work together to make a reality of community care.

The care programme approach has been introduced to improve the delivery of services to people with severe mental illness and minimise the risk that they lose contact with mental health services. Its essential elements are assessment of health and social need, a written care plan, nomination of a key worker, and regular review. It requires interprofessional collaboration and negotiation of care plans with users and carers but individual patients vary in their needs for multidisciplinary involvement and review.

This paper examines the relationship between noncompliance with depot medication and readmission to hospital of patients with schizophrenia. Noncompliance is associated with being of no fixed abode and readmission under the Mental Health Act. The merits of a community supervision order are discussed.

General practice fund-holders purchase secondary care for their patients directly, encouraging competition between providers. The scheme now includes almost all community mental health services. Practice counsellors may now be funded from secondary care budgets. Fund-holders may use their purchasing power to influence out-patient policies, have consultant sessions in their surgeries, gain direct referral to community psychiatric nurses, resist sectorisation, or change to a different provider altogether. The implications for mental health teams and their patients are discussed. Mental health workers must define their roles very dearly, and get involved in negotiating contracts now, to influence future service provision.

The Health of the Nation – A Strategy for England is a national response to WHO'S Health for All by the Year 2000 initiative. It has great importance both because it focuses on health outcomes and because it selects mental illness as one of five priority areas. This article traces the historical background to the development of the White Paper, summarises the content of the mental illness key area and current progress in improving information and understanding and developing comprehensive services, and improving good practice. It draws out the implications for individual practitioners, users and cares, and for the working arrangements between purchasers and providers.