Strand 2. Adopting a continuum-based approach to care, treatment and safety planning

“Some of the nurses and nursing assistants were very humane and compassionate, both able to help me talk with them when I wished and also to give me enough privacy." Service user

From Observation to Intervention recommends that the current practice of allocating an observation status (also known as a level or category) is replaced by a continuum-based approach. Using observation status as the only measure of the nature and severity of a patient’s risk can lead to observation tasks being used simply to monitor a patient’s whereabouts and safety with a wider understanding of their clinical, treatment and wellbeing needs being overlooked. This, in turn, can lead to observations becoming standalone tasks, unrelated to the patient’s overall needs. It’s critical that all patients have access to interventions on a continuum informed by their wider needs as well as their deterioration factors and severity of risk.

A continuum-based approach, which supports and reflects a natural flow of interactions or interventions in response to a patient’s wider needs, puts the focus on the patient and not on their observation status. Risk assessment and management – an increasingly central focus of mental health care – can therefore become more closely related to a patient’s clinical needs.

Scaling up care interventions will sometimes be required when a patient needs to have a staff member with them all of the time for brief periods. However, providing meaningful interventions and interactions, tailored to the patient’s needs and strengths, should help to provide the patient with the support they need to carry out activities either with a staff member or on their own.

Therapeutic interventions are helpful here. They provide meaningful independent or social activity (from gardening to goal setting) and are most effective when proactive and scaled in frequency – from one or two interventions or activities per nursing shift to temporary periods of continuous intervention.

Putting guidance into practice

Adopting a continuum-based approach allows ward staff to focus on personalising interventions and meaningful activities specific to a patient’s overall needs, rather than determining interventions solely on the presence or absence of risk.

Ward staff should

  • forward plan the scaling up or down of interventions with the patient and clinical team ensuring that the right care and treatment is provided at the right time, by the most appropriate person, avoiding any unreasonable delays and clearly documenting changes to interventions in the patient’s care, treatment and safety plan
  • ensure that the patient is supported to address the issues that led to their admission – this may require access to other parties including the patient’s family and allied health professionals such as psychologists or occupational therapists
  • ensure that patients are offered a range of activities for therapy and recreation early on in their admission and that these are based on a multidisciplinary assessment of each patient’s individual needs and strengths
  • adopt an inclusive and participative approach with patients, their carers and their family

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