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Self harm and violence towards nursing staff more likely in locked up mental health patients

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Mental health patients who are locked in acute psychiatric wards are significantly more likely to engage in self harm and violence towards nursing staff than those who are not confined, UK nurse researchers have found.

Operating a ‘locked door’ policy is intended to promote safety by preventing patients from absconding and harming themselves or others.

Yet locking the doors actually increases the risk of self harm and violently attacks on nursing staff and other patients, said the team from the mental health department at City University London.

In one of the largest UK studies into exit security measures on mental health wards, the researchers studied over 50,000 responses from questionnaires and interviews with staff, patients and visitors from 130 of the 500 acute psychiatric wards in England.

They found that a ‘locked door’ policy led to patients feeling frustrated, stigmatised and depressed. It increased the risk of physical violence to others by 11% and self-harm by 20%, the researchers said.

They also found that 22% of patients in locked wards are more likely to refuse medication.

Lead researcher Len Bowers, professor of psychiatric nursing at City University London, said that less security was needed on mental health wards rather than more.

‘The findings quite clearly demonstrate that locking doors is a highly imperfect strategy,’ he said, presenting the findings at the annual Eileen Skellern lecture at London South Bank University last week.

He added: ‘There are better ways of keeping people safe and preventing them from absconding and we need to be clever about finding these.’

Ian Hulatt, RCN mental health adviser, said: ‘This research provides empirical evidence that locking patients in wards makes them feel unhelped and unhappy. [Previous] research shows that engaging patients in meaningful activity reduces levels of absconding and

‘But nurses working in this acute specialty need the support and ongoing education to help improve outcomes, and ward design and staffing levels also need to be considered.’

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