JMIR Publications

ABSTRACT

Background:

Open-door policies are recommended to reduce coercion in psychiatric wards, but evidence integrating patient perspectives on psychiatric facility openness and safety measures is limited. Traditional qualitative frameworks often lack the scope necessary to fully capture these views. We hypothesized that patients would express a preference for open-door policies and demonstrate an apprehensive stance toward closed-door wards, with an emphasis on autonomy and dignity in their care.

Objective:

To examine psychiatric patients’ perspectives on open-door policies and closed-ward treatment.

Methods:

This study utilized a hybrid questionnaire survey conducted at the University Psychiatric Clinics (UPK) Basel in September 2023, which examined psychiatric service utilization. Key factors from a meta-review, including ward relationships, environment, autonomy, legal status, coercion, perceived care entitlement, and expectations at admission and discharge, were included. A text mining approach using Latent Dirichlet Allocation (LDA), a Bayesian probability-based algorithm, was applied to identify latent topics in the textual data.

Results:

The final sample included 604 individuals, with a response rate of 19.1%. A significant majority (63.8%) rated open-door treatment as "very important" (10 out of 10 on a Likert scale). In contrast, only 21.0% of participants expressed willingness to accept treatment in locked wards, with 70.4% explicitly rejecting it. Topic modeling revealed key themes of institutional critiques, restriction, confinement, social disconnection, and autonomy as a central demand in patient sentiments regarding closed-ward treatment.

Conclusions:

Our study underscores the importance of open-door policies in psychiatric care from the patient perspective, highlighting autonomy, trust, and engagement in treatment. Aligning institutional practices with patient priorities may enhance satisfaction and treatment outcomes.