Suicidal Inpatients' Perceptions of Therapeutic and Nontherapeutic Aspects of Constant Observation

OBJECTIVE: Constant observation is a staff-intensive, costly intervention that entails continuous supervision of suicidal inpatients until they no longer express suicidal intent or behavior. This study explored patients' experiences of constant observation to determine whether they derived any therapeutic benefits beyond the intended protective benefit. METHODS: A qualitative research approach was used in which 20 suicidal psychiatric inpatients who had experienced constant observation within the past two weeks were interviewed by researchers not involved in the observation procedure. Thirteen hospital staff members and seven minimally trained lay workers or sitters provided constant observation. RESULTS: Thirteen of the 20 participants emphatically expressed positive feelings toward the observers, particularly when they perceived them as friendly and willing to help. Therapeutic benefits other than protection were largely related to observers' attitudes and behaviors. Patients reported that their dysphoria, anxiety, and suicidal thoughts were decreased by observers who were optimistic, who acknowledged the patient as a human being, who provided distraction with activities and conversation, and who gave emotional support. Nontherapeutic aspects described by participants were observers' lack of empathy, lack of acknowledgment, and failure to provide information about constant observation, as well as a lack of privacy and a feeling of confinement. CONCLUSIONS: The findings support the conclusion that constant observation is not just a protective intervention but one that has therapeutic potential. It can be enhanced if observers engage inpatients in actively supportive interventions. However, observers' perceived attitudes and behaviors can cause patients distress, which reaffirms the need for careful supervision of observers.