An Exploration of the Lived Experience of Patients and Staff Involved in Supportive Observations within a High Secure Environment

Ashworth Hospital is one of three high secure hospitals in England. It serves the North West of England, West Midlands and Wales. It provides in-patient care and treatment for men who are deemed to be a grave danger to self or others, and are detained under the Mental Health Act 1983, (amended 2007) by a court of law, in conditions of maximum security. The services and systems within a high secure environment have historically been ones that have seen patients disempowered and marginalised and ones in which the contradictory roles of care giver and guardian often co-exist. Pulsford et al. (2013) suggest there is a clear tension for staff in high secure mental health services between promoting patients’ recovery and human rights and managing risk and security (Timmons, 2010).

Supportive observation can be defined as ‘regarding the patient attentively whilst minimising the extent to which they feel that they are under surveillance’ (Department of Health, 1999, p 2) and is intended to be a therapeutic alliance between patient and staff.

The project team recognised that the increase in the use of supportive observations and the resultant cost was an issue for Ashworth Hospital. The aim of the project was to gather the experiences of patients and staff involved in supportive observations, with the aim of using this information to develop practice to achieve a more therapeutically orientated intervention. It was anticipated this would enhance the experiences of both care giver and patient and also inform policy and reduce costs. A mixed approach was used combining qualitative and quantative data. This included collecting and analysing data in relation to the hours and costs involved in supportive observations, patient and staff interviews and working with stakeholders’ values and beliefs.

At the end of the project there was a noticeable reduction in the use of supportive observations and a potential reduction in cost of the service that support the methods and approaches used with the key stakeholder groups. The project team believe that the key learning point from this project was that as key facilitators, they were in a position to enable change by engaging with staff and patients throughout the process and maintaining communication in a collaborative way that resulted in a positive outcome for all. Members of the project team have presented their work at both international and national conferences.

This project was supported by the Foundation of Nursing Studies Patients First Programme in partnership with the Burdett Trust for Nursing.