Verlauf und Einflussfaktoren der Öffnungszeiten von teiloffen geführten psychiatrischen Akutstationen

During the last decades a major international trend in psychiatric care has been the deinstitutionalisation of the care providing system. The open-door policy as an alternative style of treatment was developed in Great Britain in the fifties of the last century with a peak of popularity in the seventies. Nevertheless, there was a rather low acceptance in the German-speaking countries. The process towards a community-oriented psychiatric operating organisation has been associated with expectations to preserve or improve patients' psychosocial functioning, an improved ward atmosphere, better compliance with psychiatric treatment and acceptance of rehospitalisation. Since 1994 the Psychiatric Hospital of Zurich has a selective open-door policy under which entrance doors to wards are left unlocked except when there is risk of escape, suicide or dangerous behaviour. The present study analyses changes in the rate doors are left unlocked ("open rate") and factors that influence this rate, and this in six wards. Data concerning opening hours, structure of the wards and various clinical aspects of the inpatients such as diagnosis, suicidal danger and compulsory measures were used. The data was taken from logs of the wards and basic psychiatric statistics respectively. Consequently a questionnaire to gather the data needed was not necessary. We focussed on a period of 27 months from 1995 to 1997. The sample consisted of 4926 recorded days from five general emergency units with compulsory admission (including mentally ill offenders) and one unit specialising in depression and anxiety with a slightly different treatment setting. All five emergency units were on average (partially) open for only 14% of recorded days where the rate for the unit specialising in affective disorders was 94%. So this ward used for control purposes was mostly operated on a fully open-door basis. For the emergency units a significant downward trend in the "open rate" was observed over the course of the study period. Multiple regression was carried out to investigate factors which are relevant to the operating system of the admission units. In addition to time, forced isolation turned out to be an important predictor for the "open rate". Other variables assumed to be important did not significantly add to the prediction of the dependent variable. Contrary to the hypothesis, there is no relationship between the level of patient turnover or number of diagnoses associated with high-risk situations and the "open rate". With regard to the available data it is hardly possible to figure out the real potential factors of influence. Without doubt an open-door policy vitally depends on the size and experience of the nursing staff, the turnover of patients, patients' need for a save place and treatment aspects. If the unit has no option of refusing admission to some patients and if the unit is geared to short-stay treatment, the open-door system is inevitably restricted.