Ten Things to Look for When Placing a Loved One in Psychiatric Care

Just unlocking doors to psychiatric wards and not making other changes can put patients at greater risk. When there is a shortage of hospital beds, only the most severe cases get admitted to the hospital, and even the most ardent advocates of respecting psych patients recognize that some people need the security of locked doors. Unlocked wards as the only option are not a good idea. However, for patients who can choose their placement, and for patients who are being treated for conditions precipitated by stress, an unlocked ward works with these kinds of policies:

1. Clear, publicly stated, and mutually agreed on standards of behavior for both patients and staff. In reality, the patient's consent is likely to be minimal, as the choices may be to stay in the unlocked ward or go to a locked ward, maybe in another facility farther way from home. However, understanding what is expected is clearly of benefit to everyone involved in the ward.
2. Reminding the nursing staff of ways to de-escalate conflict with "soft words" and "soft actions" on a regular basis. Some psychiatric wards may hang different reminders in the nursing station every few days.
3. Using successful nursing staff as trainers for others, recognizing their success, giving every nurse an opportunity for recognition.
4. A requirement to say something good about every patient at every nursing turnover.
5. Staying aware of bad news patients might receive from visitors, family members, and television, and being ready to discuss it to soften emotional blows.
6. Structured, non-threatening, personal information about each patient made available to staff members in folders or other media. This would include information about favorite movies or television shows, favorite sports and sports teams, hobbies, and so on.
7. A collection of "distraction tools" such as mp3 players, light displays, blankets, and so on.
8. Regular meetings between patients and staff to bolster mutual support.
9. Reassuring statements to patients after upsetting incidents (such as an outbreak of violence, a fire alarm, failure of heating or cooling or water supply, the sudden death or illness of another patient, and so on).
10. Reassuring statements from former patients admitted to and discharged from the ward.

Acute care psychiatric wards are busy, chaotic places. Asking staff and patients to make these changes in routine is no small expectation. It takes real dedication to patient care to create a supportive environment that works with unlocked doors.

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However, just unlocking the doors is not enough to make a critical difference. "Privileges" to make brief trips to the outside world are only beneficial in the context of maintaining a truly therapeutic environment inside the psychiatric ward.

Even when psychiatric facilities do everything they can to facilitate progress for their patients, incidents still occur. Patients may "lose it" in a locked ward or in an unlocked ward. Bad news from family or on television can be upsetting no matter what the status. Patients in crisis require additional attention anywhere. But when psychiatric wards are able to create the environment supportive of patient independence, an open, unlocked ward may be ideal for all but the most critically ill patients.