title: [Comparison of Aggressive Behavior, Compulsory Medication and Absconding Behavior Between Open and Closed door Policy in an Acute Psychiatric Ward].
abstract: ObjectiveAccording to legal requirements coercive treatment must be limited to acts necessary for the protection of patients and cannot be used for institutional interests. Here, we aimed to test the hypothesis that opening psychiatric wards can reduce the number of aggressive assaults and of coercive treatment without increasing absconding rates.MethodsNumbers of absconding, coercive medication, fixation and special security actions were collected retrospectively and compared between phases of closed (N total = 409; N legally committed = 64) and 90 % of daytime opened (N total = 571; N legally committed = 99) doors in an acute psychiatric ward.ResultsDuring the phase of opened doors we observed significantly reduced aggressive assaults (p < 0,001) and coercive medication (p = 0,006) compared to the closed setting, while the absconding rate did not change (p = 0,20).LimitationGiven the retrospective non-experimental design, no causal interpretations can be drawn.ConclusionThe results suggest that open door is associated with reduction of aggressive assaults and coercive medication without increasing absconding rates. This speaks for a stronger implementation of open door policies in acute wards in order to preserve human rights in psychiatry. To collect more robust evidence for this thesis, longer phases should be monitored and moderating variables such as atmosphere and social cohesion should be assessed.
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin.
authors.forename: Mara-Lena
authors.initials: ML
authors.lastname: Cibis
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin.
authors.forename: Carolin
authors.initials: C
authors.lastname: Wackerhagen
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin.
authors.forename: Sabine
authors.initials: S
authors.lastname: Müller
authors.affiliation: Universitäre Psychiatrische Kliniken (UPK), Basel, Schweiz.
authors.forename: Undine E
authors.initials: UE
authors.lastname: Lang
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schmidt
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D003068:Coercion; D005260:Female; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D007588:Job Satisfaction; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology*; D011567:Psychiatric Department, Hospital / Q000458:organization & administration*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care; D012931:Social Environment
chemical_list: D011619:Psychotropic Drugs