Suicide and escape attempts are a disturbingly frequent phenomenon due to the fact that half of all hospital wards, which cater to psychiatric patients under the Mental Health Act use a “locked doors” approach. New research has shown that psychiatric patients who are locked up in their wards tend to exhibit more tendencies towards escaping and suicide due to feeling ‘caged up’ as compared to wards that are unlocked.

Over a period of 15 years, researchers in Germany found that patients in unlocked wards were associated to 34% lesser odds of suicide attempts and 37% lesser odds of escaping temporarily. This led to various researchers concluding that the unlocked wards would be the most optimum for psychiatric wards, as they tend to translate to increased trust between the patients and doctors.

As such, the problem tends to be the lack of care and concern shown to patients, which often increases the rates of depression, and that leads to instances of wanting to commit suicide or to escape temporarily as patients in locked up wards are not given psychiatric medications.

Singapore has moved to more open communication between doctors and patients

In Singapore, the phenomenon of locked up wards does not exist as the professionals at the Institute of Mental Health take special interest in ensuring that the patients return to the pink of health in the shortest time possible. This has resulted in the provision of facilities like diversional therapy, televisions and comprehensive programs to keep the patients engaged.

They have found that by providing patients with around-the-clock care, the patients tend to exhibit less, if not zero, tendency towards escaping temporarily or even attempting suicide. In Singapore, psychiatry wards are not locked; instead they are left open in order to have better supervision so as to ensure there are no incidents happening.

With the opening of new wards, IMH has been able to better provide care to patients. CEO of IMH, A/P Chua Hong Choon proclaimed that, “With these new facilities, we will be better able to deliver integrated and holistic healthcare to patients in more therapeutic environments.”

Locked wards create “prison” sensation

Lead study author Dr. Christian Huber, a psychiatry researcher at the University of Basel in Switzerland noted, “There will always be situations where safety measures like intensive care, seclusion, restraint, or involuntary medication have to be used on an individual basis,” but added that, “An important aspect of psychiatric care is to help restore a patient’s confidence and self respect (as well as controlling symptoms) and this is not helped by them being locked up.”

Professor Len Bowers, who did a similar research in 2008, has claimed that locked wards can stimulate the feeling of a prison which affects the patients further psychologically and can translate into unruly behavior from them. He has also stated that psychiatric wards should be unlocked with staff placed at the entrance to check who enters and who leaves.

Meanwhile, Huber also pointed out, “Hospitals without locked wards may be able to provide similar protection through improved focus on the patient-therapist relationship, therapeutic atmosphere and timely, sufficient pharmacotherapy.”

On the whole, more nurses and mental health nurse assistant prefer the locked doors method as it would mean lesser work for them and most importantly, it protect patients from harming others, including the care providers. However, what is lacking is the dire understanding of the psychological changes that the patients go through behind the locked doors, which the care providers are not able to go through. MIMS

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Sources:
http://www.channelnewsasia.com/news/health/locked-psychiatric-wards/3032486.html
https://www.theguardian.com/society/2008/nov/30/mental-health-nhs-locked-wards
https://www.imh.com.sg/clinical/page.aspx?id=243
http://www.straitstimes.com/singapore/health/institute-of-mental-health-opens-new-wards-to-treat-mood-disorders-early-psychosis
https://www.researchgate.net/publication/7224917_Psychiatric_wards_with_locked_doors-Advantages_and_disadvantages_according_to_nurses_and_mental_health_nurse_assistants