To see how security measures influenced outcomes, researchers
examined data on almost 350,000 patients admitted to psychiatric
hospitals in Germany over 15 years.
Compared with treatment in locked wards, receiving care in unlocked
wards was associated with about 34 percent lower odds of a suicide
attempt, 37 percent decreased chances of escaping temporarily and 29
percent reduced risk of escaping without coming back, the study
“We assume that providing locked wards in a psychiatric hospital
does not per se improve patient safety in terms of better protection
from suicide and absconding,” said lead study author Dr. Christian
Huber, a psychiatry researcher at the University of Basel in
“This is important from our point of view, as it may mean that less
restrictive treatment settings can be used without endangering
patient safety,” Huber added by email. “Coercion in psychiatry
constitutes an ethical challenge, should always be a last resort
measure, and often impedes successful treatment.”
Researchers compared outcomes for patients who were similar in many
respects but placed on different types of psychiatric wards
including locked, partly locked or open residential facilities as
well as day clinics.
The analysis included about 270,000 people treated in hospitals with
locked wards and another 78,000 patients who received psychiatric
care at facilities without locked wards.
Overall, more patients were treated with antipsychotics,
antidepressants and mood stabilizers in hospitals with unlocked
wards. At hospitals with locked wards, a greater proportion of
patients were not given psychiatric medications.
Roughly 1 percent of patients in both care settings exhibited
self-injuring behavior during treatment, researchers report in the
The study team calculated the odds of suicides and escapes for a
subset of about 147,000 patients who could be compared to others
similar in age, mental health diagnosis and other medical conditions
and were placed on different types of wards.
While the risk of death from suicide was lower in the unlocked
wards, the difference wasn’t large enough to rule out the
possibility that it was due to chance.
One limitation of the study is that researchers could only match
about half the patients with similar people to compare the odds of
suicide and escape, the authors note.
[to top of second column]
The study also didn’t include patients at university hospitals or
private clinics, which typically can admit patients with even lower
risks of suicide or escape than the general population, the authors
point out. This means the study results might underestimate the
value of unlocked doors, the researchers conclude.
“Hospitals without locked wards may be able to provide similar
protection through improved focus on the patient-therapist
relationship, therapeutic atmosphere and timely, sufficient
pharmacotherapy,” Huber said.
This approach has its limits.
“There will always be situations where safety measures like
intensive care, seclusion, restraint, or involuntary medication have
to be used on an individual basis,” Huber added.
One advantage of unlocked doors, however, is that they convey a
level of trust that can improve doctor-patient relationships and
make therapy more effective, Tom Burns, a psychiatry researcher at
the University of Oxford in the U.K. wrote in an accompanying
“An important aspect of psychiatric care is to help restore a
patient’s confidence and self respect (as well as controlling
symptoms) and this is not helped by them being locked up,” Burns
said by email. “I think that the default position should be that
patients are admitted to open wards and only moved to locked wards
in the instances when they fail to settle.”
SOURCE: http://bit.ly/2b3VBH6 Lancet Psychiatry, online July 28,
[© 2016 Thomson Reuters. All rights
Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.