Self-harming behavior is a frequent problem seen at patients admitted to closed wards in psychiatric hospitals. People who self-harm have al higher risk of other forms of aggressive behavior as well. Little is known about prevalence and characteristics of this behavior, the preceding triggering factors and the relation with other aggressive behaviors.

To gain insights in the self-harming behavior of patients admitted to a closed ward in a psychiatric hospital.

From September 2019 till January 2021 information on self-harming incidents and aggressive behavior towards others or objects, of 27 patients admitted to the closed department of the Centre Intensive Treatment (Centrum Intensieve Behandeling), has been gathered. The Self-Harm Scale and Social Dysfunction and Agression Scale were used to gather the data.

Twenty of 27 patients examined (74%) showed self-harming behavior. Head banging (41,9%) and self-harming using straps/ropes (30%) occurred most. Tension/stress as triggering factor was mentioned most (19,1%), followed by reliving (13,5%) and team interaction (11,8%). Self-harming behavior occurred more in evenings then during the rest of the day. No significant difference was found in the degree of aggressive behavior towards others or objects between the group of patients harming themselves and the group that didn’t.

This study delivers insights in self-harming behavior of patients admitted to closed psychiatric departments that can be used for prevention and treatment.

No significant relationships.

Psychiatric inpatient treatment is increasingly performed in settings with locked doors. However, locked wards have well-known disadvantages and are ethically problematic. In addition, recent data challenges the hypothesis that locked wards provide improved safety over open-door settings regarding suicide, absconding and aggression. Furthermore, there is evidence that the introduction of an open-door policy may lead to short-term reductions in involuntary measures. The aim of this study was to assess if the introduction of an open-door policy is associated with a long-term reduction of the frequency of seclusion and forced medication.

In this 6-year, hospital-wide, longitudinal, observational study, we examined the frequency of seclusion and forced medication in 17,359 inpatient cases admitted to the Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Switzerland. In an approach to enable a less restrictive policy, six previously closed psychiatric wards were permanently opened beginning from August 2011. During this process, a systematic change towards a more patient-centered and recovery-oriented care was applied. Statistical analysis consisted of generalized estimating equations (GEE) models.

In multivariate analyses controlling for potential confounders, the implementation of an open-door policy was associated with a continuous reduction of seclusion (from 8.2 to 3.5%; ηp2 = 0.82; odds ratio: 0.88) and forced medication (from 2.4 to 1.2%; ηp2 = 0.70; odds ratio: 0.90).

This underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.