Impact of the concept of “Open Doors” on coercive measures - A pre-/post- comparison

Abstract

Intro

With the intention of reducing restraints and increasing patient autonomy, the “Open Doors” policy (ODP) is an intensely discussed alternative to the tradition of closed wards. The aim of this study was to investigate the impact of the ODP on coercive measures, the need for staff presence and critical incidences among involuntarily admitted patients after implementation in a general psychiatric hospital.

Methods

Retrospectively, data were collected from involuntarily admitted patients before and after the implementation of the concept of “Open Doors” based on the electronic patient's medical records. Data comprised socio-demographic and clinical information with focus on coercive measures, staff presence and critical incidences.

Results

There was a moderate reduction in coercive measures after the introduction of the ODP. More specifically, recurrent mechanical restraints, combinations of different kinds of coercive measures as well as one-to-one supervision were applied less often. Regarding critical incidences, there were more abscondings, yet their duration was shorter and there were less suicide attempts recorded.

Conclusion

The results suggest that the ODP can be effective in reducing coercive measures applied among involuntarily admitted patients. However, it should be noted that this may not only be due to the opening of the ward doors, but may also be related, for example, to a change in the therapeutic relationship or a change in the ward climate. Thus, prospective and qualitative studies could give a more differentiated insight into the effect of the ODP.