The Lovisenberg study of Open-door policies in acute mental healthcare: developing and evaluating a service innovation to minimize coercion

I 2024 publiserte LOADS hovedfunn som tilsier at Åpen dør policy i døgnposter i psykisk helsevern er like trygt som vanlig 'beste praksis' med låste dører; under innleggelsene på Åpen dør policy skjedde det ingen økning i farlige hendelser, eller i tvangsbruk, eller på liggetid eller annen ressursbruk. Pasienter innlagt på Åpen dør policy post oppga at de var mer tilfreds med behandlingsmiljøet enn de som var i vanlig behandling; dette ga seg utslag i større følelse av trygghet i posten, og mer opplevd støtte til bedring/behandling. Åpen dør policy poster hadde også en lavere andel pasienter som oppga å ha en høy opplevelse av tvang. I prosjektperioden var hoveddøren på Åpen dør policy postene åpne i mer enn 70% av åpningstiden fra 09-21. Pasientene som ble innlagt på de to typene poster var likefordelt (randomisert), og det var derfor ingen forskjell mellom gruppene i hvor stor andel som var ufrivillig innlagt (rundt 75%), var vurdert med forhøyet voldsrisiko (rundt 50%), andel kvinner (rundt halvparten), andel med diagnose i schizofrenispekteret (rundt 50%) eller alder. Artikkelen ble publisert i Lancet Psychiatry i mars 2024 og manuskriptutgave er åpent arkivert på https://www.duo.uio.no/handle/10852/110648

Freedom of movement is a fundamental human right that is systematically restricted in acute psychiatry to address safety, prognosis and/or staffing concerns. The legitimacy and therapeutic impact of the current state-of-the art ‘locked door’ practice has recently been called into question by the United Nations, the WHO, user organisations, and the Norwegian Government. Lovisenberg Diaconal Hospital wishes to implement and test a new service model, open-door policies, to increase patient freedom and reduce coercion in their inner-city acute psychiatric wards. The Lovisenberg Open Acute Door Study (LOADS) RCT will randomly assign admitted acute psychiatric patients to two open-door policy wards or state-of-the-art locked-door wards for 12 months. The RCT will be followed by a 4-year observational period to report on data beyond the RCT. The hypothesis is that open-door care will be equivalent to - or better than locked-door care. The risk of insufficient involvement of staff and management is addressed via an action-based implementation model: The Clinic Director retains the psychological ownership of the project, and invests considerable resources and time in engaging and listening to the opinion of staff, users, and external collaborators in dialogue on the design and implementation of the open-door service model. This also reduces the risk of insufficient research management, as the project manager for the research component need not constantly pressure staff and management to contribute but can focus on study design, results analyses and dissemination. Ordinary risk of insufficient inclusion (selection bias) and incomplete data are addressed by the designation of LOADS as a health services research project that will utilise routinely collected data from all admitted patients rather than being based on acutely ill patients providing informed consent. The RCT addresses the risk of selection bias in comparing old and new service models.