Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards

Muir‐Cochrane, Eimear; Merwe, Mariè van der; Nijman, Henk; Haglund, Kristin; Simpson, Alan; Bowers, Len

doi:10.1111/j.1447-0349.2011.00758.x

Cited by 38 publications

(76 citation statements)

References 12 publications

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“…Patients have been shown to experience feelings of distress such as aggression, anger, irritation, depression and low self-esteem during treatment on a locked acute psychiatric ward [12,13]. Haglund and von Essen [14] showed that locked doors may evoke feelings of confinement, forced dependence on staff or negative emotions in voluntarily admitted inpatients.…”

Section: Introductionmentioning

confidence: 99%

“…A German study found that admission to an open ward was associated with a more positive experience than admission to a locked ward [17]. Furthermore, opening and locking doors may increase the workload for nurses and reduce time for engagement in therapeutic activities with patients [13,14,18]. …”

Section: Introductionmentioning

confidence: 99%

“…Haglund and von Essen [14] showed that locked doors may evoke feelings of confinement, forced dependence on staff or negative emotions in voluntarily admitted inpatients. By staff and patients alike, locked wards may be perceived as an uncaring and stigmatising environment [13,14,15]. In psychotic patients who were admitted for the first time, 80% described treatment as traumatic and 38% were diagnosed with posttraumatic stress disorder associated with admission [16].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. Results: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. Conclusions: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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“…61 A survey of patient, staff and visitor perceptions found that whilst there was general agreement that locking doors appeared to reduce absconding, staff expressed feelings of guilt, embarrassment and fear of being blamed when a patient absconded. 62 Staff also reported that open wards created anxious vigilance to prevent absconding and increased the workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door and expressed depression, a sense of stigma and low self-esteem when the door was locked.…”

Section: Absconding and Locked Mental Health Unitsmentioning

confidence: 96%

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

Scott

Meehan

2016

Psychiatry, Psychology and Law

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“…In particular, ratings of self-esteem, self-efficacy and optimism and control over the future were higher among inpatients than among service users in the community. This finding initially appears counterintuitive, given that the doors of inpatient units are often locked, reportedly creating feelings of depression and low self-esteem, 153 and that service users are more likely to face a range of restrictions. 154 However, on reflection and in the light of some of the qualitative data in which service users outline how the period in hospital had been a necessary and important stage in their recovery, perhaps this is more understandable.…”

Section: Making Connections In Inpatient Mental Health Care Planning mentioning

confidence: 99%

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link

Cited by 38 publications

References 12 publications

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

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