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Constant Observation of Suicidal Patients

The Intervention We Love to Hate


Journal of Psychiatric Practice®: September 2016 - Volume 22 - Issue 5 - p 382–388
doi: 10.1097/PRA.0000000000000175

Constant observation (CO) of psychiatric inpatients at risk for suicidal behavior has been criticized in the literature because of the absence of demonstrable effectiveness, associated costs, staff and patient acceptance, and related issues. Our inability to demonstrate effectiveness, however, is an ethical conundrum that cannot readily be solved. Frequent and often vociferous references in the literature to the absence of an evidence base for this intervention carries the risk that CO may be underutilized in particular clinical circumstances with untoward results. A case is made for shifting focus from the lack of evidence supporting CO to agreement on an observation protocol that achieves the desired goal of maximizing patient safety. A sample protocol is presented.

RUSS: Vice Chair for Clinical Programs and Medical Director, New York-Presbyterian/Westchester Division, White Plains, NY; and Associate Professor of Clinical Psychiatry, Department of Psychiatry, Weill Cornell Medical College, New York City, NY

The author declares no conflicts of interest.

Please send correspondence to: Mark J. Russ, MD, New York-Presbyterian/Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605 (e-mail:

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