[What replaces the locked door? : Conceptual and ethical considerations regarding open door policies, formal coercion and treatment pressures].

Abstract

BACKGROUND\nMental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy.\n\n\nOBJECTIVE\nTo provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures.\n\n\nMETHODS\nEmpirically informed conceptual and ethical analysis.\n\n\nRESULTS\nThe replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a\xa0differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors.\n\n\nCONCLUSION\nUnexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.