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Value of locking doors on mental health hospital wards questioned

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Locked-door policies in mental health hospitals are no better than open doors at preventing patient suicide or unauthorised absence, according to a study.

It found treating people with mental ill health in hospitals with locked wards, as opposed to hospitals without locked wards, does not reduce their risk of suicide attempts or of absconding.

“A locked-door policy probably imposes a more oppressive atmosphere”

Christian Huber

The 15-year study of around 145,000 German patients suggests an open-door policy may foster a better therapeutic atmosphere and promote better health outcomes on psychiatric wards.

Although the researchers cautioned that the findings may not apply to all countries, they said the study raises important questions for mental health services worldwide.

Practice varies widely across Europe and seems to be mainly based on local tradition, as there has been little evidence to date to justify this practice in favour of an open-door policy, they noted.

Universitäre Psychiatrische Kliniken Basel

Study questions value of locking doors on psychiatric wards

Christian Huber

The study authors analysed data from 21 hospitals, gathered between 1998 and 2012, to examine the association between locked- or open-door policies and the rates of suicide, suicide attempts, and absconding in patients.

Main diagnoses included organic disorders, substance use disorders, schizophrenia spectrum disorders, affective disorders, stress related disorders, and personality disorders.

The researchers found that suicide attempts and completed suicide did not differ significantly between hospitals with an open-door policy compared to hospitals without.

Absconding rates – with or without return – were not increased in hospitals with an open door policy, according to the findings published in The Lancet Psychiatry journal.

Among patients who did leave without authorisation, they were more likely to return when under the care of an open-door hospital, than if they were being treated in a locked hospital or ward.

Similarly, patients who were treated on an open ward were less likely to attempt suicide than patients who were treated on a locked ward.

“Throughout western psychiatry we are witnessing a shift to ever more compulsion and control”

Tom Burns

Patients treated on open and day clinic wards had a lower likelihood of absconding, either with or without returning, compared with locked and partly locked wards.

Study author Dr Christian Huber, from the Universitäre Psychiatrische Kliniken Basel in Switzerland, said: “These findings suggest that locked-door policies may not help to improve the safety of patients in psychiatric hospitals, and are not generally successful in preventing people from absconding.

“In fact, a locked-door policy probably imposes a more oppressive atmosphere, which could reduce the effectiveness of treatments, resulting in longer stays in hospital,” he said. “The practice may even lend motivation for patients to abscond.”

In Germany, there are about 1.1 psychiatric care beds for 1,000 inhabitants, whereas in the UK and there are 0.5 beds – meaning that countries with fewer beds are potentially more likely to only admit severely ill patients at greatest risk of harm to themselves.

University of Oxford

Study questions value of locking doors on psychiatric wards

Tom Burns

Professor Tom Burns, from the psychiatry department at the Warneford Hospital in Oxford, said: “Throughout western psychiatry we are witnessing a shift to ever more compulsion and control.

“At its most basic, this increased compulsion reflects a casualness about patients’ rights that calls for urgent attention—virtually every national code of practice is committed to the concept of the least restrictive alternative,” he said.

He added: “This increase in control might also indicate a more worrying trend—a neglect of attention to establishing trusting relationships with troubled and severely mentally ill individuals.

“If we lose the emphasis on this core skill from our training and practice, it could be very difficult to re-establish,” warned Professor Burns.

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Readers' comments (1)

  • Patients suffering mental health problems find locked wards the biggest issue, they make one very aggressive when on a sunny day they are not allowed to sit outside although even though they did not pose any risk of suicide or absconding.
    They would have been better treated in prison.
    In our local psychiatric hospital bedrooms are also locked, patients are not allowed to keep any kind of snacks / fruit in their lockers, are not allowed to keep our mobile phones cutting them off from the outside world. They sat around much of the day with nothing to do but explode from the frustration they feel, then end up in isolation.
    Whilst I agree that 'sectioned' patients may need to be in locked wards, I see no reason why everyone else should have to be confined for the benefit of the few.
    In a prison you can phone family, buy snacks and keep them in your cell, have a nap in the daytime if one so wished, but none of this is allowed in our local hospital. Many psychiatric drugs can make one feel very unwell, yet they have to sit if full view of other patients and suffer the misery they feel.
    In the 70's our hospital opened up so many of the wards where patients posed little risk, now they are all locked again and the suicide rate has risen.
    We talk a lot about patient privacy and dignity but in mental health care, there is very little of either and compassion somewhat thin on the ground.
    These are not hospitals, they are prisons!

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