L’ouverture des services en psychiatrie : effets et paradoxes

Abstract

Aims

Via a brief history of Open-Door Policy (ODP) in psychiatry, we discuss its implications and consequences in daily practice (in ethical, clinical, and psychopathological terms). We think that open-door policy in psychiatry is a tool of care in its own right.

Method

We conducted a literature review to analyze ODP in psychiatry in Europe and also made use of clinical experience in a psychiatric hospital in Marseille, France.

Results

ODP in this hospital is not a daily decision; we would otherwise have good reasons to close our doors every day. This is a collective position and we bear the risks of the collective, free coming and going of caregivers and patients. It requires us to get out of the zero-risk policy mindset, which we consider an impossible and paralyzing ideal.

Discussion

Several studies comparing open- and closed-door policy in psychiatry suggest that open-door services have less recourse to coercive measures. The ODP produces concrete effects for patients and caregivers, beyond the freedom of movement or its restriction.

Conclusion

ODP allows for new clinical and transferential modalities due not only to the openness but also the renewal of patients’ fundamental rights to freedom. ODP maintains a better long-term therapeutic collaboration between patients and caregivers.