The practice of locking doors at psychiatric wards has been brought into question by a major 15-year study in Germany.
Researchers at Universitäre Psychiatrische Kliniken studied the cases of around 145,000 patients and found locking doors did not reduce the risk of suicide attempts or absconding.
In fact, the authors say an open-door policy leads to better health outcomes.
“These findings suggest that locked-door policies may not help to improve the safety of patients in psychiatric hospitals, and are not generally successful in preventing people from absconding,” says lead researcher Dr Christian Huber. “A locked-door policy probably imposes a more oppressive atmosphere, which could reduce the effectiveness of treatments, resulting in longer stays in hospital. The practice may even lend motivation for patients to abscond.”
The study, published in The Lancet Psychiatry journal, gathered information from 21 German hospitals between 1998 and 2012. The patients examined had a range of conditions including substance-use disorders, schizophrenia, mood disorders such as depression, stress-related disorders and personality disorders.
The data showed that suicide attempts and completed suicide did not differ significantly between those hospitals that locked their doors and those that didn’t. Patients who left without authorisation were more likely to return when under the care of an open-door hospital.
Although the researchers only looked at German hospitals, they say the findings should be considered by mental health services worldwide. “Our study suggests that the safety of locked wards for the prevention of suicide or self-harm might be overestimated, and patients at high-risk of self-harm or suicide may be lost from treatment,” says Dr Huber.