No benefit to locked mental health wards: 15yr study

A once 'sound' idea is now in question.

A 15-year study has concluded that there is no benefit in locking up many mentally ill patients.

Looking at about 350k cases, the researchers selected 145 738 cases, matched for propensity around suicide attempts. In open units, elopement and suicide attempts were less frequent than in locked units.

An open-door policy could be preferable for those with depression, anxiety or psychosis, as it promoted a better therapeutic atmosphere and more positive health outcomes

Even if this large study is imperfect, it gives us a perfect illustration that what seems sensible or logical does not necessarily result in the expected outcome. Although it makes sense that locking people up should not only help them stay put but also keep them safe,, that seems not to be the case.

Counterintuitive? Yes. But brains and bodies often do not conform to the rules of logic. This is in part due to the fact that we have only a superficial understanding of the complexity of our behaviours and physiology. 

How else are we hurting people when we think we are helping them? 

The full article is in Lancet Psychiatry


Choosing Wisely: Five Things Nurses and Patients Should Question

Nurses are on the frontline of medicine. They know their patients well, support them through every moment of their stay in hospital, and are responsible for a lot of decisions that can help (or harm) patients. 

Since providing high-value and safe care is not just about decisions in the patient-physician encounter, the Choosing Wisely initiative have partnered with The American Academy of Nursing to create a list of 5 things Nurses and Patients should question: 

  1. Don’t automatically initiate continuous electronic fetal heart rate (FHR) monitoring during labor for women without risk factors; consider intermittent auscultation (IA) first.
  2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
  3. Don’t use physical restraints with an older hospitalized patients
  4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
  5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.

Read in more detail at Choosing Wisely or see the PDF.

The American Academy of Nursing is not the only non-physician group to have their own list; the American Physical Therapy Association (APTA)  also has a list. In addition, there has been broad collaboration with representatives of the other professional roles in the health care team during the development of The Choosing Wisely campaign.

Many of the society lists were created with the involvement of multidisciplinary teams and patient groups, recognizing the fact that it's going to take engagement at all levels to make a meaningful change that is good for patients and good for our healthcare system.