Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study

Schneeberger, Andres R.; Kowalinski, Eva; Fröhlich, Daniela; Schröder, Katrin; Felten, Stefanie von; Zinkler, Martin; Beine, Karl H.; Heinz, Andreas; Borgwardt, Stefan; Lang, Undine E.; Bux, Donald A.; Huber, Christian G.

doi:10.1016/j.jpsychires.2017.08.017

Cited by 53 publications

(45 citation statements)

References 18 publications

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“…This does not necessarily have to result in an increase of seclusion or coercive interventions in general. On the contrary, there is evidence that coercive interventions including seclusion can be significantly reduced by the introduction of an open-door policy [ 11 , 14 , 37 ]. Furthermore, there are less restrictive and voluntary alternatives to seclusion such as “soft rooms” which are already known from “Soteria” concepts [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…All such demands and provisions aim to ensure the safety of the patients or others as best as possible while limiting the patients’ freedom as little as possible. There is data that opening the doors might lead to less aggressive incidents [ 14 , 15 ] and that absconding and suicide rates are not higher compared with closed settings [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

et al. 2018

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BackgroundTreating legally committed patients on open, instead of locked wards is controversially discussed and the affected stakeholders (patients, mental health professionals) have ambiguous views on the benefits and disadvantages. The study aims to assess the opinions and values of relevant stakeholders with regard to the requirements for implementing open wards in psychiatric hospitals.MethodsSemi-structured interviews were conducted with 15 psychiatrists, 15 psychiatric nurses and 15 patients, and were analyzed using qualitative content analysis.ResultsThe interviewees identified conceptual, personnel and spatial requirements necessary for an open door policy. Observation and door watch concepts are judged to be essential for open wards, and patients appreciate the therapeutic value they hold. However, nurses find the door watch problematic. All groups suggest seclusion or small locked divisions as a possible way of handling agitated patients. All stakeholders agree that such concepts can only succeed if sufficient, qualified staff is available. They also agree that freedom of movement is a key element in the management of acutely ill patients, which can be achieved with an open door policy. Finally, the interviewees suggested removing the door from direct view to prevent absconding.ConclusionsFor psychiatric institutions seeking to implement (partially) open wards, the present results may have high practical relevance. The stakeholders’ suggestions also illustrate that fundamental clinical changes depend on resource investments which – at least at a certain point – might not be feasible for individual psychiatric institutions but presumably require initiatives on the level of mental health care providers or policy makers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

et al. 2018

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“…They reported on a group of direct care psychiatric nurses who created a performance improvement programme that resulted in a decrease in the use of seclusion and restraint. No additional funds were required to develop this programme with early results showing a 75% reduction in the use of seclusion and restraint with no increase in patient or staff injuries since its implementation (56).…”

Section: Hospital-based Initiativesmentioning

confidence: 99%

“…Christian Huber and colleagues argued that there is insufficient evidence that treatment on locked wards can effectively prevent absconding, suicide attempts, and death by suicide (59). Andres Schneeberger and colleagues, drawing on two large-scale studies based on data for 349 574 admissions to 21 German psychiatric inpatient hospitals from 1998, to 2012, indicated that hospitals with an 'open door policy' did not have increased numbers of suicide, suicide attempts, and absconding with return, and without return (56,59). Conversely, they reported that treatment on open wards correlated with a decreased probability of suicide attempts, absconding with return, and absconding without return, but not completed suicide (59).…”

Section: Hospital-based Initiativesmentioning

confidence: 99%

Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies

Gooding

McSherry

Roper

2020

Acta Psychiatr Scand

101

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Preventing and reducing 'coercion' in mental health services: an international scoping review of Englishlanguage studies. This article discusses initiatives aimed at preventing and reducing 'coercive practices' in mental health and community settings worldwide, including in hospitals in high-income countries, and in family homes and rural communities in low-and middle-income countries. The article provides a scoping review of the current state of English-language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals' rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non-Englishlanguage studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.

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“…Another factor exerting an effect on the level of aggression and violence with respect to medical staff is the type of ward. Analysis of a 15-year period of the functioning of 21 German psychiatric hospitals showed that no differences were observed in the forms of aggression occurring in closed and open wards; however, in open wards, the necessity for carrying out interventions to control aggressive behaviours was significantly lower [28].…”

Section: Discussionmentioning

confidence: 90%

Sense of safety among medical staff working in a psychiatric ward

Ciebiera¹,

Orzeł²,

Włoszczak-Szubzda³

et al. 2019

Med Og Nauk Zdr.

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Introduction and objective. Acts of aggression and physical violence directed against medical staff decrease the sense of work safety, resulting in the depersonalisation and gradual departure of medical staff from the profession. The aim of the study was to investigate the sense of safety among medical staff employed in the psychiatric ward of a Polish provincial hospital. Materials and method. The pilot study included 88 persons who represented various medical professions employed in a psychiatric ward of the Independent Public Provincial Specialist Hospital in Chełm, The discussed phenomenon was evaluated by a survey method, by means of an author-constructed questionnaire as a research instrument. Statistical analysis was conducted using statistical software SPSS. Results. The majority of medical personnel working in the psychiatric ward in the Independent Public Province Specialist Hospital in Chełm reported that the work in the ward is associated with a low sense of safety. Only the respondents who had the lowest period of employment (less than 5 years) evaluated work in the psychiatric ward as safe. Those with the longest period of employment in the psychiatric ward felt less secure; simultaneously, the respondents' admitted that being on duty together with persons who had the longest period of employment was the safest. No statistically significant differences in the lack of the sense of safety at work in a psychiatric ward were observed according to gender. Conclusions. Statistically significant differences were noted between respondents' opinions concerning their alleviating effect on releasing aggressive behaviours. Such an opinion was expressed mainly by paramedics.

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Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study

Cited by 53 publications

References 18 publications

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies

Sense of safety among medical staff working in a psychiatric ward

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