The prevalence of constant supportive observations in a high, medium and low secure service

Abstract

Aims and Method
We explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single NHS mental health trust. From clinical records, we extracted data on the length of time on CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014.

Results
A small number of individuals accounted for a disproportionately large amount of CSO hours in each setting. Adverse incident rates were higher on CSO than when not on CSO. There was considerable variation between different settings in terms of CSO use and the reasons for commencing CSO.

Clinical Implications
The study describes the prevalence and nature of CSO in secure forensic mental health services and the associated organisational costs. The marked variation in CSO use between settings suggests that mental health services continue to face challenges in balancing risk management with minimising restrictive interventions.