The care programme approach (CPA) was introduced to improve coordination of care for people with severe mental illness (SMI). The aim of this study was to establish the proportion of perpetrators of homicide in contact with mental health services receiving care under enhanced CPA and to examine the quality of care received. The method involved a national clinical survey of homicide perpetrators in contact with mental health services in England and Wales. The results were as follows: Of 380 homicide perpetrators in recent contact with services, 264 (69%) were not receiving care under enhanced CPA, including 26 (49%) with SMI and previous violence. Of 107 patients under enhanced CPA, 35 (37%) were non-compliant and 40 (42%) had disengaged from services at the time of the offence; services had attempted to re-establish compliance in 10 cases and contact in 17 cases (43%). All high-risk patients should be supervised under enhanced CPA and standardisation of its use is required.