What replaces the locked door?: Conceptual and ethical considerations regarding open door policies, formal coercion and treatment pressures

Abstract

Background: Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy. Objective: To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures. Methods: Empirically informed conceptual and ethical analysis. Results: The replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors. Conclusion: Unexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.