Objective: Examination of the process of therapeutic observation, as performed by nursing staff on acute assessment wards, from the perspective of adult inpatients.

Method: One week after admission, patients were asked to complete a questionnaire, enquiring whether they had noticed their observation, and the extent to which they found it intrusive. Diagnoses were categorised by ICD–9, from the case-notes. Chi-square was used to analyse the results.

Results: Fifty six per cent of patients perceived changes in the intensity of their observation. Psychotic patients were significantly more likely than the rest (p = 0.016) to feel that they were observed too closely, despite not being uncomfortable with this. There was a trend for patients in the traditional psychiatric hospital to feel more discomfort than those on a psychiatric ward in the district general hospital (p = 0.12).

Conclusion: Respect for privacy and dignity may notentirely be attainable for the most vulnerable group of psychotic patients. Opportunities may exist to improve matters with the closure of asylums and attention to ward layout and design.