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Prior research shows that locked doors and coercive measures are not only applied due to safety concerns, but also due to the specific local tradition of an institution. We examined the association of the use of coercive measures and the admission to a locked ward with person-related characteristics compared to the admission to a specific clinic. In this 15-year, naturalistic observational study, we examined 230,684 admissions to 14 German psychiatric inpatient clinics from Jan 1, 1998, to Dec 31, 2012. To analyze the degree to which admission to a locked ward and coercive measures (received vs. not received) were connected with person- and clinic-specific factors, two-step logistic regression analyses were applied. 27% of the variance of the admission to a locked ward were explained by person-related characteristics (Nagelkerke r2 = 0.269). By adding the clinic the person was admitted to, the explained variance increased by 15% (Nagelkerke r2 = 0.418). 36% of the variance of the use of coercive measures were explained by person-related characteristics (Nagelkerke r2 = 0.364). By adding the clinic the person was admitted to, the explained variance increased by 4% (Nagelkerke r2 = 0.400). The local tradition of a psychiatric clinic seems to play a more prominent role for the decision to admit a person to a locked ward than for the decision to use coercive measures. Clinicians should be made aware of the connection of local traditions with clinical pathways in acute psychiatry to avoid unnecessary admissions to locked wards. [ABSTRACT FROM AUTHOR]

Despite the reform efforts of the last decades modern acute psychiatry still stands between conflicting priorities in everyday practice. The protection of patient autonomy might conflict with a regulatory mandate of psychiatry in societal contexts and the necessity of coercive measures and involuntary treatment might become problematic with respect to presumed but contentious interests of the patient. The conflicts particularly concern questions of involuntary commitment, door closing, coercive and isolation measures. Research on the topic of therapeutic effectiveness of these practices is rare. Accordingly, the practice depends on the federal state, hospital and ward and is very heterogeneous. Epidemiological prognosis predicts an increase of psychiatric disorders; however, simultaneously in terms of medical ethics the warranty of patient autonomy, shared decision-making and informed consent in psychiatry become increasingly more important. This challenges structural and practical changes in psychiatry, particularly in situations of self and third party endangerment which are outlined and a rationale for an opening of the doors in acute psychiatric wards is provided. [ABSTRACT FROM AUTHOR]