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Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study
- Source :
- Journal of Psychiatric Research. 95:189-195
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear. This study had a naturalistic observational design and analyzed the occurrence of aggressive behavior as well as the use of seclusion or restraint in 21 German hospitals. The analysis included data from 1998 to 2012 and contained a total of n = 314,330 cases, either treated in one of 17 hospitals with (n = 68,135) or in one of 4 hospitals without an open door policy (n = 246,195). We also analyzed the data according to participants' stay on open, partially open, or locked wards. To compare hospital and ward types, we used generalized linear mixed-effects models on a propensity score matched subset (n = 126,268) and on the total dataset. The effect of open vs. locked door policy was non-significant in all analyses of aggressive behavior during treatment. Restraint or seclusion during treatment was less likely in hospitals with an open door policy. On open wards, any aggressive behavior and restraint or seclusion were less likely, whereas bodily harm was more likely than on closed wards. Hospitals with open door policies did not differ from hospitals with locked wards regarding different forms of aggression. Other restrictive interventions used to control aggression were significantly reduced in open settings. Open wards seem to have a positive effect on reducing aggression. Future research should focus on mental health care policies targeted at empowering treatment approaches, respecting the patient's autonomy and promoting reductions of institutional coercion.
- Subjects :
- Adult
Hospitals, Psychiatric
Male
Restraint, Physical
Safety Management
medicine.medical_specialty
Poison control
Violence
Suicide prevention
Patient Isolation
03 medical and health sciences
0302 clinical medicine
Germany
Mentally Ill Persons
Injury prevention
Humans
Medicine
Psychiatry
Biological Psychiatry
Aged
Inpatients
business.industry
Aggression
Middle Aged
Open door policy (business)
Organizational Policy
030227 psychiatry
Psychiatry and Mental health
Propensity score matching
Female
Observational study
medicine.symptom
business
Seclusion
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 00223956
- Volume :
- 95
- Database :
- OpenAIRE
- Journal :
- Journal of Psychiatric Research
- Accession number :
- edsair.doi.dedup.....430099504baf328042df0293f9bc6e53
- Full Text :
- https://doi.org/10.1016/j.jpsychires.2017.08.017