[Open doors in psychiatric hospitals : An overview of empirical findings]

Nervenarzt. 2019 Jul;90(7):680-689. doi: 10.1007/s00115-019-0738-y.
[Article in German]


Background: Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue.

Method: Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives.

Results: A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards.

Discussion: Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.

Keywords: Coercion; Involuntary commitment; Locked doors; Open door policy; Psychiatry.

Publication types

  • Systematic Review

MeSH terms

  • Europe
  • Hospitals, Psychiatric* / standards
  • Humans
  • Mental Disorders* / therapy
  • Prospective Studies
  • Psychiatry* / methods
  • Psychiatry* / organization & administration
  • Psychiatry* / standards