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Locked Door Psychiatric Units Have More Disadvantages Than Advantages

Armen Hareyan's picture

Psychiatric Units

The disadvantages of locking the front doors of psychiatric unitsoutnumber the advantages by more than two to one, according to a studypublished in the latest Journal of Clinical Nursing.

Researchers from Uppsala University in Sweden interviewed 40 mentalhealth nurses and nursing assistants working on seven Swedishpsychiatric inpatient wards with locked entrance doors.

The majority of patients in their care (45 per cent) had beendiagnosed with mood disorders, 33 per cent had anxiety, personality orother disorders and 22 per cent had schizophrenia and psychoticdisorders.

Eight advantages and 18 disadvantages were cited by the staff and most of these concerned patients' experiences.

"Enabling staff to control patients was felt to be an advantageby 85 per cent of staff, providing patients with secure and efficientcare by 73 per cent and protection against the outside world by 68 percent" says lead author Kristina Haglund.

"We know where the patients are" commented one member of staff,while another said that "it gives patients a sense of security when theward is locked." Another said that family members were relieved to"know that the patient is safe and secure."

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But there were twice as many disadvantages to contend with.

"The most common disadvantage, mentioned by 83 per cent ofrespondents, was that controlling the door was an uncomfortable andtime-consuming task for staff, which could interrupt ongoing duties orcontact with patients" adds Kristina Haglund.

"75 per cent felt that having a locked door could reducepatients' self-confidence and feeling of personal responsibility."48 per cent also expressed worries that it created a non-caringenvironment and could make patients feel that they had to depend onstaff to open the door."

One member of staff expressed concern that rattling keys could"intensity the 'prison' atmosphere" and others worried that it added"to the feeling of illness", caused "agitation" or made patients"passive". Staff also talked about difficult issues relating tovoluntary patients who didn't need to be locked in.

Locked doors also made staff question their role. "At the sametime that you are caring for a patient you must be a sort of guard too"said one respondent. Other staff said it made them feel "shut-in".

There was also practical concern that locked doors could be a hindrance in an emergency.

Just over half of the staff surveyed (53 per cent) had alsoworked on an open door psychiatric unit. The majority (70 per cent)were female and the average age of the 20 registered nurses was 52