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NCISH / Resources / Implementing a personalised approach to risk / Personalised approach to risk: learning event 7

Personalised approach to risk: learning event 7

An icon of a hospital bed.Observation, self-harm and suicide risk: the importance of emotional and psychological safety

Monday 10 November 2025

On this page:

Recording of the session

Observation, self-harm and suicide risk

At this learning event, we discussed the evidence and practice for observation, self-harm and suicide. We also highlighted the importance of taking a compassionate and relational approach throughout the assessment process.

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Research and reports

This NCISH study examines the characteristics of in-patients who died by suicide under observation and their service-related antecedents. Patient deaths were associated with less experienced staff members or staff unfamiliar with the patient, absconding, and deviation from observation procedures.

Over a quarter (28%) of in-patient suicide deaths occurred while the patient was under enhanced nursing observation. Patients under enhanced observation were more likely to have been detained under the Mental Health Act and to have died within the first week of admission (see page 22 of the report (PDF)).

This paper discusses the use of surveillance technology in mental health services. The authors describe three vignettes illustrating the use of this technology in practice.

This report focuses on the use continuous observation (defined as the practice where one or more members of staff continuously engage with and observe the patient to reduce their risk of self-harm). Findings suggest a lack of evidence on how to best use continuous observation. National guidelines and standards on this practice are limited, meaning there is wide variation in its use between healthcare providers.

This paper describes a quality improvement methodology employed by an NHS Trust in England to test interventions aimed at improving completion of observations and therapeutic engagement. Improvements were seen in observation completion with decreases in incidents of violence, verbal and racial aggression, restrictive practices, and staff sickness.

In this Personal View, the authors argue that emotional safety is crucial for psychiatric in-patients to keep themselves physically safe, and that the absence of emotional safety compromises care.

This qualitative study aimed to understand patients’ experiences of intermittent observations on psychiatric wards at night. Patients expressed that environmental disturbances (for example, light and noise) and the invasion of privacy associated with observations contributed to sleep disturbance. Patients felt that poor sleep quality had a significant adverse impact on their psychological and social wellbeing.

This paper argues that intermittent observations have little purpose and causes sleep disruption for patients. Unless patients are judged to be at immediate risk of self-harm, sleep should be prioritised, and patients should be placed on general observations.

This paper evaluates a package of measures aimed at improving sleep for children and young people admitted on psychiatric in-patient wards. After implementation, 57% of patients had a protected sleep period. No increase in incidents was identified, with a decrease in hypnotics being prescribed.

This paper reviews the historical development of therapeutic communities and critically evaluates their current theory, practice and outcomes in a systematic review.

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NHS England resources

This guidance details the core commitments and standards for the culture of inpatient care. The standards are aligned with three principles of support equality-focused inpatient care: autism-informed, culturally competent and trauma-informed.

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Patient perspectives

The Stop Oxevision campaign aims to raise awareness around the use of Oxevision, a monitoring system used to observe patients remotely. This blog compiles information on Oxevision. You can find lived experience testimonies under the Lived Experience tab.

This statement from Neurodiverse Connection highlights five areas of concern related to the use of Oxevision: consent, privacy and dignity, psychological impact, surveillance as restrictive practice, and data sharing.

The National Survivor User Network website compiles news articles related to surveillance and policing in mental health settings.

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