Aiming to understand what sort of treatment facility is helpful for mentally-challenged patients, a recent study conducted in over 70,000 patients in Germany has found that suicide attempts as well as flight risk of patients are fewer in psychiatric hospitals that used an open door policy rather than a closed door one.

While suicide and self-harm is linked to mental distresses, Christian Huber, the lead researcher in the study, wanted to see the effect open door and closed door psychiatric facilities have on its patients. The 15-year long observational study analyzed the inpatient records of 21 different German hospitals from 1998 to 2012. Using the records of 349,574 patients they compared suicide attempts, rates of suicide and absconding in relation to open door and closed door policies of such facilities.

The study, published in Lancet Psychiatry, observed 72,869 cases and matched them with respective hospitals so that the results would allow for accurate comparisons between the two policies. They saw how many hospitals had a greater rate of suicide attempts, completed suicides and observed whether that hospital opted for a closed door policy or not. The finding for completed suicides and suicide attempts were more or less same in hospitals that had open door policies with those that had closed door policies. However, the differences arose when comparing the absconding of patients. Patients who were admitted to open door facilities or day clinics had a lowered risk of flight, with or without return, than those patients who were restricted to closed door policies.

“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,” said Christian Huber.

In recent years, mental health problems are getting the importance that they deserve with people finally recognizing the existence of such mental illnesses and working towards offering a better lifestyle to those who suffer from it. And yet, even with the awareness in reducing the stigma against mental health, there is a lot that needs to be done. In USA alone, 43.6 million adults suffer from AMI (any mental illness), according to a survey conducted in 2014. In UK, it is reported that one in every four people suffers from mental health problems in a given year, while World Health Organization (WHO) reports that 20% of all children and adolescents in the world have mental disorders.

With such a high prevalence of mental illness throughout the globe, psychiatric facilities and treatment centers offer a reprieve for the mentally ill. However, statistics indicate that suicide rates of those admitted to these facilities are still growing, with more than 40,000 reported suicides in 2013 in USA, according to CDC. People who are mentally ill, depending on their illness, can suffer from suicidal ideation with different disorders stating suicide as one of its many symptoms.

Closed door policies are implemented in mostly those cases where the risk of flight in a patient is higher or chances of patient causing harm to themselves and to others is elevated. In such situations, these patients are separated from others and restricted from joining in on outdoor activities. With severe shortages of patient beds, more so in the USA than in Germany, admitting patients is only done so for those who are at a greater risk to themselves and society. USA employs an inpatient policy where as soon as the patient is deemed not dangerous, they are discharged to a lower level care. Recently, a new proposal for psychiatry facilities aimed at lessening the length of stay to 5 days and suggestions of letting family and friends’ visitation rights was also given. Such policies that allow the patient proper treatment while not locking and isolating them from the community, can help the patient more on their road to recovery.

The study highlighted this ideology as well since the rate of people leaving the facilities permanently or leaving to return was less when the psychiatric hospitals had open door policies. Reasons of why patients choose to abscond are associated with aggressive incidents with others around them. In Germany for every 1,000 patients admitted there are 1.1 patient beds, indicating a severe shortage of beds in such facilities. Such situations where patients are locked in close quarters with others not only increase risks of aggression amongst patients but also provide a threatening atmosphere that causes a person to flee. In an open door policy, giving the patient the freedom to come and leave, it has been seen that while many still opt to abscond, they do in fact return later on.

Other similar studies, one led by Undine A Lang, also supported the open door policy to closed, stating that 17% of the patients felt stigmatized and isolated when placed in locked rooms, thereby increasing their desire to abscond when given the chance. Furthermore, the closed door policy not only took away the patients’ freedom but was reportedly causing increased emotional distress and dependence on staff. The study also highlighted that an open door policy would lead to an improved relation between staff and patient. When the confinement is removed, the patient is able to see staff members as their helpers rather than those who have imprisoned them. It also improves the work environment on staff members who don’t have to employ coercive measures to detain patients or use aggressive tactics that can be difficult on their psyche.

By allowing patients the freedom to accept and leave their treatment, it provides a positive environment upon which the patient is likely to stay on board. If they do intend to abscond, as the study proves, the probability of them returning is far greater than when admitted to a closed door facility.