Tensions and Risks in the Blanket Use of Locked Door Policies in Acute Mental Health Inpatient Facilities: Balancing Human Rights, Clinical Utility and Public and Patient Protection

Wardle, Jon

doi:10.1080/13218719.2014.987901

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…A lack of clear policy and reporting guidelines was also found in this review, with Ashmore's (2008) qualitative study noting that many nurses were confused on the policy for locking doors, and several responses indicate that many nurses would not know where to seek guidance on the locked door policy. As highlighted earlier in this review, some jurisdictions have moved to locking doors permanently in recent years (Gill et al, 2021), with several ethical and legal concerns arising due to this practice (Wardle, 2015). For example, if consumers are admitted voluntarily to acute inpatient mental health units with locked doors, there is an argument that they are effectively involuntary without the ability to leave at any time.…”

Section: Discussionmentioning

confidence: 99%

Locked external doors on inpatient mental health units: A scoping review

Searby

James

Snipe³

et al. 2023

Int J Mental Health Nurs

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The principles of least restrictive care and recovery‐focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery‐focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least‐restrictive, therapeutic environments.

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Section: Discussionmentioning

confidence: 99%

Locked external doors on inpatient mental health units: A scoping review

Searby

James

Snipe³

et al. 2023

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…However, the validity of this practice is questionable, as the only options available to patients are to be admitted under the locked door policy, or to be denied access to inpatient treatment. Reviews of international literature on the clinical utility and impact of locked door policies have found that there is limited evidence about the benefits of locked wards (McSherry, 2014; Wardle, 2015). There is mixed evidence about whether locked doors reduce absconding and there is evidence that locked wards change clinician–patient relationship from a therapeutic to a custodial emphasis (Haglund et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…A review of 35 Australian policy documents related to mental health found that Queensland’s state-wide locked ward directive is unique among Australian states and found that ‘ Australian policies regarding acute mental health services make little mention of “door locking” policies and procedures in services ’ (Fletcher et al, 2019: 540). There appears to be a general lack of transparency and inconsistency regarding the locking of the doors in inpatient units across Australia (Wardle, 2015). We have been able to confirm with Office of the Chief Psychiatrist (or equivalent) in South Australia, Victoria, Western Australia and New South Wales that locking a ward is a local decision based on clinical needs including the need to prevent harm to individual patients on the ward, as well as the needs and safety of the community of patients and staff.…”

Section: Introductionmentioning

confidence: 99%

Opening the doors: Critically examining the locked wards policy for public mental health inpatient units in Queensland Australia

Gill

Parker

Amos

et al. 2021

Aust N Z J Psychiatry

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The Queensland Government issued a policy directive to lock all acute adult public mental health inpatient wards in 2013. Despite criticism from professional bodies and advocacy for an alternative, the policy has been retained to this day. A blanket directive to treat all psychiatric inpatients in a locked environment without individualised consideration of safety is inconsistent with least restrictive recovery-oriented care. It is against the principles of the United Nations Convention on the Rights of Persons with Disabilities, to which Australia is a signatory. It is also contrary to the main objects of the Mental Health Act 2016 (Qld). Queensland Health has reported a reduction in ‘absences without permission’ from psychiatric inpatient wards after the introduction of the locked wards policy; however, no in-depth analysis of the consequences of this policy has been conducted. It has been argued that patients returning late or not returning from approved leave is a more common event than patients ‘escaping’ from mental health wards, yet all may be counted as ‘absent without permission’ events. A review of the international literature found little evidence of reduced absconding from locked wards. Disadvantages for inpatients of locked wards include lowered self-esteem and autonomy, and a sense of exclusion, confinement and stigma. Locked wards are also associated with lower satisfaction with services and higher rates of medication refusal. On the contrary, there is significant international evidence that models of care like Safewards and having open door policies can improve the environment on inpatient units and may lead to less need for containment and restrictive practices. We recommend a review of the locked wards policy in light of human rights principles and international evidence.

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