From Observation to Intervention

From Observation to Intervention is all about putting the focus on the patient, rather than their observation status. In 2015, the Scottish Government made a commitment to developing new observation practice guidance in response to concerns about the effectiveness of existing policy and practices – concerns that were upheld by the Mental Welfare Commission for Scotland. It was clear that a radical change to the culture and practice of observation was required and, with the support of six test NHS Boards, Healthcare Improvement Scotland began to test and develop new and innovative ways of working.

In 2019, we published a guidance document – From Observation to Intervention: A proactive, responsive and personalised care and treatment framework for acutely unwell people in mental health care – to support and challenge all mental health care practitioners to move away from the traditional practice of enhanced observation and work instead towards a framework of proactive, responsive, personalised care and treatment which puts the patient firmly at its centre. This approach, which we hope will be in place by March 2019 across all NHS Boards, is in line with emerging evidence on new areas of practice – such as trauma-based care and high and low intensity psychological therapies – that may be particularly effective for patients with complex mental health issues.

Critically, our new guidance views observation as one small part of mental health care practice; it should not be undertaken as a standalone task but as part of a continuum-based approach that supports a natural flow of interactions or interventions in response to a patient’s wider clinical and wellbeing needs.

From Observation to Intervention is aimed at all mental health care practitioners and strongly recommends that personalised care, treatment and safety plans are drawn up for every patient, informed by their individual clinical needs, strengths, and indicators of deterioration and harm. Plans should be developed alongside each patient’s advance statement, their carer’s views and the reason they’ve been admitted to hospital.

Our guidance is underpinned by seven principles

• Understanding the lived experience of patients and their families and engaging their participation, consent and choice about treatment and care.
• Creating physical environments which are fit for purpose, therapeutic and as far as possible hazardous free. This should be supported by regular audits which takes account of any recent safety notices.
• Developing a model of care based on emerging evidence about trauma-informed care environments and the treatment of complex mental health issues and behaviours such as personality disorder, self-harm and violence.
• Creating ward systems that value anticipation, early recognition of deterioration and triggers for harm, as well as personalised early response mechanisms and support for all patients.
• Introducing education, training and clinical supervision or action learning for staff to ensure they have the competencies and capabilities to respond to the demands of contemporary, complex, mental health care delivery.
• Supporting a relational-based approach to care and treatment in order to foster engagement with patients.
• Embedding a human rights based approach and engaging with the Rights in Mind pathway to support patients’ rights in all mental health settings.

For more information, please refer to our From Observation to Intervention (PDF) guidance document.