title: The locked psychiatric ward: hotel or detention camp for people with dual diagnosis.
abstract: BACKGROUND
  The concepts of autonomy and liberty are established goals in mental health care; however, involuntary commitment is used towards people with mental health and substance abuse problems (dual diagnosis).
  
  
  OBJECTIVE
  To explore how patients and staff act in the context of involuntary commitment, how interactions are described and how they might be interpreted.
  
  
  METHODS
  Ethnographic methodology in a locked psychiatric ward in Norway.
  
  
  RESULTS
  Two parallel images emerged: (a) The ward as a hotel. Several patients wanted a locked ward for rest and safety, even when admission was classified as involuntary. The staff was concerned about using the ward for real treatment of motivated people, rather than merely as a comfortable hotel for the unmotivated. (b) The ward as a detention camp. Other patients found involuntary commitment and restrictions in the ward as a kind of punishment, offending them as individuals. Contrary, the staff understood people with dual diagnoses more like a generalized group in need of their control and care.
  
  
  CONCLUSIONS
  Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.
authors.affiliation: Department of Health and Nursing Science.
authors.forename: Toril Borch
authors.initials: TB
authors.lastname: Terkelsen
authors.forename: Inger Beate
authors.initials: IB
authors.lastname: Larsen
mesh_terms: D003134:Commitment of Persons with Psychiatric Disorders; D017831:Diagnosis, Dual (Psychiatry); D006282:Health Personnel / Q000523:psychology*; D006778:Hospitals, Psychiatric; D006801:Humans; D009664:Norway