The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures

Jana S Krückl; Julian Moeller; Lukas Imfeld; Sabine Schädelin; Lisa Hochstrasser; Roselind Lieb; Undine E Lang; Christian G Huber

doi:10.3389/fpsyt.2023.1268727

The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures

Front Psychiatry. 2023 Oct 25:14:1268727. doi: 10.3389/fpsyt.2023.1268727. eCollection 2023.

Authors

Jana S Krückl^{1

2}, Julian Moeller^{1

2}, Lukas Imfeld¹, Sabine Schädelin³, Lisa Hochstrasser¹, Roselind Lieb², Undine E Lang¹, Christian G Huber¹

Affiliations

¹ University Psychiatric Clinics Basel (UPK), University of Basel, Basel, Switzerland.
² Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.
³ Department Clinical Research, c/o University Hospital Basel, Basel, Switzerland.

Abstract

Introduction: Psychiatric treatment on a ward with open-door policy is associated with reduced numbers of coercive measures. The effect of the door policy of previous stays, however, has not been investigated.

Methods: The data set consisted of 22,172 stays by adult inpatients in a psychiatric university hospital between 2010 and 2019. Pairs of consecutive stays were built. The outcome variable was the occurrence of coercive measures during the second stay.

Results: Compared to treatments on wards with a closed-door policy at both stays, treatments on wards with an open-door policy at the second stay had smaller odds for coercive measures (OR ranging between 0.09 and 0.33, p < 0.01). In addition, coercive measures were more frequent in treatment histories where patients previously treated on a closed ward were admitted to a ward with an open-door policy and subsequently transferred to a ward with a closed-door policy at the second stay (OR=2.97, p = 0.046).

Discussion: Treatment under open-door policy is associated with fewer coercive measures, even in patients with previous experience of closed-door settings. The group of patients who were admitted to a ward with an open-door, then transmitted to a ward with a closed-door policy seem to be prone to experience coercive measures. Clinical strategies to keep these patients in treatment in an open-door setting could further reduce coercive measures.

Keywords: coercive measures; open doors; open-door policy; psychiatry; seclusion.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. JK is supported by an internal research grant of the UPK to CH.