L Hochstrasser1, D Fröhlich2, A R Schneeberger3, S Borgwardt2, U E Lang2, R-D Stieglitz4, C G Huber2. 1. Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland. Electronic address: lisa.hochstrasser@upkbs.ch. 2. Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland. 3. Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland; Psychiatrische Dienste Graubünden, 220, Loëstrasse, 7000 Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, 3331, Bainbridge Avenue, Bronx, New York, NY 10467, USA. 4. Universitäre Psychiatrische Kliniken Basel, Universität Basel, 27, Wilhelm Klein-Strasse, 4012 Basel, Switzerland; Universität Basel, Fakultät für Psychologie, Abteilung für Klinische Psychologie und Psychiatrie, 60/62, Missionsstrasse, 4055 Basel, Switzerland.
Abstract
BACKGROUND: Psychiatric inpatient treatment is increasingly performed in settings with locked doors. However, locked wards have well-known disadvantages and are ethically problematic. In addition, recent data challenges the hypothesis that locked wards provide improved safety over open-door settings regarding suicide, absconding and aggression. Furthermore, there is evidence that the introduction of an open-door policy may lead to short-term reductions in involuntary measures. The aim of this study was to assess if the introduction of an open-door policy is associated with a long-term reduction of the frequency of seclusion and forced medication. METHOD: In this 6-year, hospital-wide, longitudinal, observational study, we examined the frequency of seclusion and forced medication in 17,359 inpatient cases admitted to the Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Switzerland. In an approach to enable a less restrictive policy, six previously closed psychiatric wards were permanently opened beginning from August 2011. During this process, a systematic change towards a more patient-centered and recovery-oriented care was applied. Statistical analysis consisted of generalized estimating equations (GEE) models. RESULTS: In multivariate analyses controlling for potential confounders, the implementation of an open-door policy was associated with a continuous reduction of seclusion (from 8.2 to 3.5%; ηp2=0.82; odds ratio: 0.88) and forced medication (from 2.4 to 1.2%; ηp2=0.70; odds ratio: 0.90). CONCLUSION: This underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.
BACKGROUND:Psychiatric inpatient treatment is increasingly performed in settings with locked doors. However, locked wards have well-known disadvantages and are ethically problematic. In addition, recent data challenges the hypothesis that locked wards provide improved safety over open-door settings regarding suicide, absconding and aggression. Furthermore, there is evidence that the introduction of an open-door policy may lead to short-term reductions in involuntary measures. The aim of this study was to assess if the introduction of an open-door policy is associated with a long-term reduction of the frequency of seclusion and forced medication. METHOD: In this 6-year, hospital-wide, longitudinal, observational study, we examined the frequency of seclusion and forced medication in 17,359 inpatient cases admitted to the Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Switzerland. In an approach to enable a less restrictive policy, six previously closed psychiatric wards were permanently opened beginning from August 2011. During this process, a systematic change towards a more patient-centered and recovery-oriented care was applied. Statistical analysis consisted of generalized estimating equations (GEE) models. RESULTS: In multivariate analyses controlling for potential confounders, the implementation of an open-door policy was associated with a continuous reduction of seclusion (from 8.2 to 3.5%; ηp2=0.82; odds ratio: 0.88) and forced medication (from 2.4 to 1.2%; ηp2=0.70; odds ratio: 0.90). CONCLUSION: This underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.
Authors: Benjamin D Arnold; Julian Moeller; Lisa Hochstrasser; Andres R Schneeberger; Stefan Borgwardt; Undine E Lang; Christian G Huber Journal: Front Psychiatry Date: 2019-08-09 Impact factor: 4.157
Authors: Daniela Fröhlich; Christin Bittersohl; Katrin Schroeder; Daniel Schöttle; Eva Kowalinski; Stefan Borgwardt; Undine E Lang; Christian G Huber Journal: Front Psychiatry Date: 2020-01-14 Impact factor: 4.157
Authors: Sou Bouy Lo; Christian G Huber; Andrea Meyer; Stefan Weinmann; Regula Luethi; Frieder Dechent; Stefan Borgwardt; Roselind Lieb; Undine E Lang; Julian Moeller Journal: PLoS One Date: 2022-04-01 Impact factor: 3.240