Christian Betteridge uses a case study to show how this controversial measure can, when implemented sensitively and with an engagement ethos, lead to positive outcomes for everyone involved

Close observations are only used as a last resort to manage risk in inpatient mental health facilities and have been widely criticised for offending the dignity and privacy of service users. However, despite a reduction in the frequency of close observations as a result of initiatives such as Safewards, they continue to be used in contemporary inpatient practice.

In this article, a case study shows that they can be carried out in a systematic, evidence-based manner, focusing on client-practitioner rapport to preserve dignity, increase service-user satisfaction and provide therapeutic opportunity. This contrasts with the perception of the measure being degrading and controlling. The client, family and multidisciplinary team should all be involved in the decision making and in regular reviews.

Staff may feel anxious and uncomfortable when close observations are prescribed. This should be addressed with appropriate staff training and supervision so that the strategy can be followed in a calm, positive and objective manner.