Reduction of seclusion on a hospital-wide level: Successful implementation of a less restrictive policy

• Published in: Journal of psychiatric research Vol. 54; pp. 94 - 99
• Main Authors: Jungfer, Hermann-Alexander, Schneeberger, Andres R., Borgwardt, Stefan, Walter, Marc, Vogel, Marc, Gairing, Stefanie K., Lang, Undine E., Huber, Christian G.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.07.2014; Elsevier
• Subjects: Acute psychiatric treatment; Adult; Aggression; Autonomy; Biological and medical sciences; Closed ward; Coercion; Coercive measures; Compulsory measures; Female; General aspects; Hospitalization; Humans; Longitudinal Studies; Male; Medical sciences; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; Observational research; Open doors; Patient Care - methods; Patient Isolation - statistics & numerical data; Patient Isolation - utilization; Patient Satisfaction; Policy making; Psychiatric Department, Hospital - organization & administration; Psychiatric Department, Hospital - statistics & numerical data; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Restraint, Physical; Seclusion; Severity; Statistics, Nonparametric; United Kingdom; Open doors; Aggression; Coercive measures; Acute psychiatric treatment; Closed ward; Compulsory measures; Policy; Acute; Hospital environment; Implementation; Seclusion; Treatment; Mental disorder
• ISSN: 0022-3956; 1879-1379; 1879-1379
• DOI: 10.1016/j.jpsychires.2014.03.020

Change of treatment policy from closed to open ward settings has been shown to reduce coercive measures. The aim of the current study was to examine the effects of the change from closed to open wards on the frequency of seclusion and forced medication in a hospital-wide setting. 2-year, longitudinal observational study with 2838 inpatient cases. On a hospital-wide level, the percentage of patients with at least one seclusion was decreased significantly (χ2(1) = 5.8; p = .016), while there was no significant change in forced medication (χ2(1) = .08; p = .775). The frequency of seclusions and forced medication decreased significantly on newly opened wards, and there were no significant changes regarding seclusion on permanently closed or open wards, while the number of forced medications increased significantly on closed wards. The decrease in seclusions on newly opened wards remained statistically significant after controlling for diagnoses and severity of illness. Our results indicate that a reduction of overall seclusion can be successfully attained, and that, in particular, the frequency of seclusion and forced medication on newly opened wards was decreased significantly. These changes were not accompanied by a significant increase in seclusion on other wards. Open ward treatment was successfully implemented and was associated with a significant decrease of coercive measures in our study. It might therefore provide a good care model, strengthening the patient's right to autonomy and leading to a reduction of coercive measures.