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Engagement and observation: a review of local policies in England and Wales

Russell Ashmore (Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK)

Mental Health Review Journal

ISSN: 1361-9322

Article publication date: 14 May 2020

Issue publication date: 14 July 2020




The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales.


Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis.


All organisations had a specific policy referring to either “observation and engagement” or “observation”. The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement.

Research limitations/implications

This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice.

Practical implications

Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with.


To the best of the author’s knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation.



Ashmore, R. (2020), "Engagement and observation: a review of local policies in England and Wales", Mental Health Review Journal, Vol. 25 No. 2, pp. 169-183.



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