title: Reduction of seclusion on a hospital-wide level: successful implementation of a less restrictive policy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  2-year, longitudinal observational study with 2838 inpatient cases.
  
  
  RESULTS
  On a hospital-wide level, the percentage of patients with at least one seclusion was decreased significantly (χ(2)(1) = 5.8; p = .016), while there was no significant change in forced medication (χ(2)(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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland; Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Hermann-Alexander
authors.initials: HA
authors.lastname: Jungfer
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland; Psychiatrische Dienste Graubünden, Loëstrasse 220, CH-7000 Chur, Switzerland.
authors.forename: Andres R
authors.initials: AR
authors.lastname: Schneeberger
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Walter
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Vogel
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Stefanie K
authors.initials: SK
authors.lastname: Gairing
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Undine E
authors.initials: UE
authors.lastname: Lang
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland. Electronic address: christian.huber@upkbs.ch.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Huber
mesh_terms: D000328:Adult; D003068:Coercion; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D010356:Patient Isolation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011567:Psychiatric Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D012149:Restraint, Physical; D018709:Statistics, Nonparametric; D006113:United Kingdom
keywords: Acute psychiatric treatment; Aggression; Closed ward; Coercive measures; Compulsory measures; Open doors