Journal scan

Locked doors do not help patient wellbeing in mental health units

Prevention of suicides or reducing absconding is not improved by restricting freedom.

Patients in psychiatric wards may have better health outcomes if an ‘open door’ policy is operated.

Open door health

A report in The Lancet Psychiatry suggests that traditional locked-door wards are not effective in reducing patient suicide attempts, or eliminating unauthorised absence.

On the contrary, a 15-year study in Germany of 145,000 patient cases concludes that fewer restrictions create a more therapeutic atmosphere and promote better health outcomes.

While the authors caution that the findings may not apply to all countries, they say the study challenges general preconceptions.

By analysing data from 21 German hospitals from 1998-2012, the report – compiled by researchers at the Universitäre Psychiatrische Kliniken Basel in Switzerland – concludes that rates of suicide attempt and completed suicide did not differ significantly between hospitals with an open-door policy compared to those without.

Similarly, absconding rates (with or without return) were not increased in hospitals with an open-door policy.

Lead author Dr Christian Huber says: ‘[Locked-door policies] probably impose a more oppressive atmosphere, which could reduce the effectiveness of treatments, and may even lend motivation for patients to abscond.’

In a linked comment, Professor Tom Burns of Oxford University adds: ‘Throughout western psychiatry we are witnessing a shift to ever more compulsion and control which might indicate a more worrying trend; a neglect of establishing trusting relationships with troubled and severely mentally ill individuals.’


Huber CG, Schneeberger AR, Kowalinski E et al (2016) Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year observational study. The Lancet Psychiatry. doi: 10.1016/S2215-0366(16)30168-7

This article is for subscribers only