Observation of People with Mental Health Problems

A revision of the 1995 CRAG document Nursing Observation of Acutely Ill Psychiatric Patients in Hospital to bring it in line with current clinical practice and policy terminology.



  • Each local service should have a system of observation practice in place that is flexible and responsive to patient need and based upon Millan's ten principles.

  • Policies implementing each component of observation practice should be clear and unambiguous in terms of:

  • role

  • responsibility

  • reaction

  • reporting

  • to safeguard all those involved in the observation process.

  • The environment in which observation practice is carried out should be shown to be safe and suitable through a system of regular audit within the Trust's risk management and clinical governance processes.

  • Staff should be trained in the skills and competencies required to practise observation and be supervised in their practice of this therapeutic activity. An understanding of both risk assessment and psychological interventions is required by all staff, and the Trust should be able to demonstrate that this is regularly reviewed and attended to.

  • A system of recording must be in place that enables clear communication between staff members and ensures regular assessment and recording of risk. The system must allow immediate comprehension of the process as it applies at any moment to an individual and support an audit trail which enables the review of clinical incidents.

  • Written patient information on the principles and practice of observation should be drawn up locally and provided to each patient.

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