Special Observations in the Care of Psychiatric Inpatients: A Review of the Literature and Developments in Practice

Special observations are commonly used on mental health inpatient wards as an intervention with acutely ill patients who are at risk of harm to themselves, harm to others or absconding. Attention has turned to looking for alternatives to special observations, partly because of the resources that are devoted to the practice in the context of the strain on services, and partly because of questions around the efficacy of the practice and the impact on patient care. There have been a number of developments that have tried to reduce levels of special observations on wards with varying success. Here, we review the literature on special observations and recent developments in the efforts to reduce the practice. There is no convincing evidence that special observations exert a positive effect on patient outcomes, but conclusive evidence is difficult to gather and there is a need for stronger evidence to inform practice.