Do locked doors in psychiatric hospitals prevent patients from absconding?

Abstract

Background and Objectives: In the acute treatment of acute psychiatric patients coercive measures are often required and therapeutic relationships can be affected by such measures. In this study we assessed whether opening the entrance door of an acute psychiatric ward influences absconding behaviour. Methods: An acute psychiatric ward was primarily closed (91.4%) for six months and primarily open (75.6%) for six months over the time period of one year. In this one year period, 337 patients were treated (206 male, age: 40 ± 16 years): 60.2% of the patients had schizophrenia, 13.6% had affective disorders, 11.6% suffered from addiction and 14.5% displayed other diagnoses. Results: In terms of age (t = 0.026, df = 335, p = 0.979), gender (chi2 = 1.6, df = 1, p = 0.13), diagnoses (chi2 = 7.337, df = 1, p = 0.062) and duration of stay (t = -0.90, df = 335, p = 0.928), we found no significant differences between the patients admitted in the closed and those admitted in the open ward period. Absconding (df = 1, chi2 = 5.107, p = 0.029), aggressive incidents (chi2 = 4.46, df = 1, p = 0.050) and coercive medications (chi2 = 4.646, df = 1, p = 0.037) were observed significantly more often in the closed door period. Moreover, the duration up to readmission was reduced in the closed time period (t = 2.314, df = 54, p = 0.025). Conclusions: We hypothesize that open doors reduce patient's discomfort, improve ward atmosphere and aggressive acts and do not appear to increase the risk of absconding.