Zusammenfassung
Ziel Überprüfung der These, dass offene Stationstüren Aggressivität und Zwangsbehandlung reduzieren ohne Entweichungsraten zu erhöhen.
Methode Vergleich der genannten Zielparameter zwischen durchgehend geschlossenen (n gesamt = 409; n untergebracht = 64) und zu 90 % geöffneten (n gesamt = 571; n untergebracht = 99) Türen einer Akutstation.
Ergebnisse Bei offenen Türen traten signifikant weniger aggressive Übergriffe und Zwangsmedikationen auf, während Entweichungsraten nicht zunahmen.
Schlussfolgerung Offene Türen scheinen mit einer Reduktion von Zwangsmedikation und Aggressivität einherzugehen, ohne dabei Entweichungsraten zu erhöhen. Dies stützt die Politik der offenen Tür zur Umsetzung der Menschenrechte in der Psychiatrie.
Abstract
Objective According to legal requirements coercive treatment must be limited to acts necessary for the protection of patients and cannot be used for institutional interests. Here, we aimed to test the hypothesis that opening psychiatric wards can reduce the number of aggressive assaults and of coercive treatment without increasing absconding rates.
Methods Numbers of absconding, coercive medication, fixation and special security actions were collected retrospectively and compared between phases of closed (N total = 409; N legally committed = 64) and 90 % of daytime opened (N total = 571; N legally committed = 99) doors in an acute psychiatric ward.
Results During the phase of opened doors we observed significantly reduced aggressive assaults (p < 0,001) and coercive medication (p = 0,006) compared to the closed setting, while the absconding rate did not change (p = 0,20).
Limitation Given the retrospective non-experimental design, no causal interpretations can be drawn.
Conclusion The results suggest that open door is associated with reduction of aggressive assaults and coercive medication without increasing absconding rates. This speaks for a stronger implementation of open door policies in acute wards in order to preserve human rights in psychiatry. To collect more robust evidence for this thesis, longer phases should be monitored and moderating variables such as atmosphere and social cohesion should be assessed.
Schlüsselwörter Politik der offenen Tür - Entweichungsrate - Akutstation - BGB - PsychKG - Zwangsbehandlung - Menschenrechte in der Psychiatrie
Keywords open door policy - absconding behavior - acute wards - coercive treatment - human rights in psychiatry
