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A lingering question at even the top mental health hospitals is whether psychiatric wards should be locked or open. The answer seems to be that different patients have different needs.

In the English speaking world, actor Boris Karloff set the stage for the public perception of the top mental health hospitals of his day with the movie Bedlam, released in 1946. Like several other horror movies, several television series, and a number of books, Bedlam was based on the experiences of patients at Bethlem Royal Hospital, the world's longest operating psychiatric hospital, in operation nearly 700 years.

The Bethlem Hospital became synonymous with "bedlam," a state of chaos, disorder, and irrationality. The hospital also gave another word to the English language during the service of its administrator Helkiah Crooke, who kept patients naked and starving while pocketing the royal allotment to their care to his own pocket. Naturally, such places had to be kept under lock and key, if only to protect the guilt of their administrators. Reaction to the horrific conditions of older psychiatric hospitals led to modern policies of open wards.

How Can Unlocked Doors Help in the Treatment of Mental Illness?

The idea of opening psychiatric wards to the world began to be expounded in the psychiatric literature a few years after the movie Bedlam played in movie theaters. Appleton, Wisconsin psychiatrist Keith M. Keane proposed a number of reasons for unlocking psychiatric wards as early as 1957:

  • "Early, intensive" treatment could reduce the length of stay even for suicidal, violent, or paranoid patients from months to weeks.
  • Even psychotic patients respond to be treated with respect.
  • Maximum security measures retard the recovery of suicidal patients. To get better, they need to handle situations in which psychiatry staff has to trust them.
  • When family is understanding and patient, discharge home is preferable to staying in the hospital.
  • The care of psychiatric patients is not limited to psychiatrists. Non-psychiatrist doctors and non-psychiatric nurses can reinforce the work done by psychiatric staff.

When Dr. Keane died in 2011 at the age of 91, he was eulogized as "the most normal psychiatrist anyone ever knew." Many of his patients noted that his approach to their care, including them in the same hospital as other kinds of patients, offering them more contact with the outside world, kept them from taking on the attitude of invalids. By the end of Dr. Keane's lifetime, about half of psych wards in the UK and a somewhat smaller percentage in the US were using locked doors. 

How Great Is the Benefit of Having an Open Psych Ward?

There was a small body of evidence showing some benefits in mental patients' not considering themselves prisoners and not treating psychiatric staff like jailers. London City University Professor Len Bowers found that locked psychiatric wards have 11 percent more incidents of violence, 20 percent more self-harm, and 22 percent more refusal of medication. Patients in locked wards are far less likely to escape and commit suicide, but the are significantly more likely to experience feelings of low self-worth. 

The secret to success with an open psychiatric ward, however, is that it takes more than just keeping the doors unlocked to help patients get well. If you or your loved one needs in-hospital psychiatric treatment, there are a number of factors that enhance success.

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