Eileen Skellern 2008

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Mental health expert calls for less, not more, security on psychiatric wards

Less, not more, security is needed on mental health wards to reduce depression, self-harm and aggressive behaviour amongst patients and towards nurses, finds one of the UK’s largest research projects into exit security measures on wards.

  Professor Len Bowers is to present these findings at the annual Eileen Skellern Lecture on 2nd December 2008. They are the result of a 4 year large scale research project by Professor Bowers and his research team in City University London’s mental health department, funded by the National Institute for Health Research (NIHR) Service Delivery and Organisation Programme.

  During the lecture, he will explain that doors on acute psychiatric wards are frequently kept locked to prevent patients from leaving and harming themselves or others. Yet this research shows that locking doors actually increases feelings of frustration, social exclusion, stigmatisation, and depression, which lead to patient aggression, self-harm and treatment refusal.

  The researchers also analysed the link between increased security and levels of absconding. They found that whilst absconding is reduced when ward doors are locked, there are alternative methods to reduce the problem that do not have the negative side effects of door locking. Professor Bowers will identify these as decreasing other ways in which patients can leave the ward unobserved, rather than locking the ward front door; providing patients with access to garden areas; a clean, high quality ward environment, and specific nursing care for those patients at risk of absconding.

  Professor Bowers says: “There is disagreement amongst psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. Despite this disagreement, year on year more and more acute psychiatric wards are becoming permanently locked.”


Over 130 of the 500 acute admission psychiatric awards in England took part in the survey and used a mix of questionnaires and face to face interviews with staff, patients and visitors. Over 50,000 responses were collected. 

Professor Bowers will conclude the lecture by explaining that to optimise the trade off between patient depression, aggression and absconding, psychiatric wards should:

  • Have a single main exit that is unlocked to those leaving during the day. This exit should have maximum visibility to the staff on duty, via the positioning of the nursing office or station, the use of mirrors, or closed circuit television.
  • Staffing numbers should be sufficient to maintain general observation of the ward and vigilance of the exit, even at times of high demand on staffing resources.
  • All acute admission wards should implement an existing and proven nursing method to reduce absconding, in full and on a continuous basis.
  • Patients judged to be at particularly high risk of harming themselves or others following absconding should be managed through psychosocial care, coupled with the judicious use of medication, observation, or transfer to a locked Psychiatric Intensive Care Unit. All acute psychiatric wards should have ready access to an intensive care service or locked extra care area
  • Although acute wards should have a single open exit, they should also have unobtrusive but effective security to prevent patients leaving via other routes.
  • All wards should provide secure and safe patient access to fresh air via a garden area or covered and enclosed (to prevent suicide attempts through jumping) internal or external balcony
  • All acute admission wards should have and maintain a high quality, spacious, clean, well decorated and furnished, welcoming environment, symbolising the high value placed on patients, the service to them, and the staff that provide it


Professor Bowers says: “This research also exposed the different view between staff and patients towards locked doors. Open doors were shown to lead to anxious vigilance on the part of staff, who found this tension provoking and uncomfortable. Whilst the emotional burdens of the locked door fall on patients, causing them to be angry and depressed.”


“It is important that hospitals find a happy medium between both staff and patients, which both reduces anxiety amongst staff as well minimising absconding, depression and aggression amongst patients.”


Notes to editor:

  Acute psychiatric wards are where the general public are admitted when they suffer from an acute mental disorder, and require extra care to promote safety, assess their condition, receive treatment and assistance with physical care (for example eating, drinking, sleeping, personal hygiene etc., through to management of medical conditions). Approximately half of such patients are admitted compulsorily under the mental health act, the rest stay voluntarily. The length of stay on such wards is generally three weeks or less, and then patients are discharged back to their usual accommodation. Most such wards are in the grounds of general hospitals, close to the local population they serve.

Acute psychiatric wards are distinct and separate from forensic services, such as medium and high security psychiatric hospitals, where most admissions come via the courts following offences committed whilst mentally ill. The recommendations of this research do not apply to such wards.

Eileen Skellern was a leading psychiatric nurse of the 1960s and 70s. The Lecture series was instituted in her honour in 1982. Further background to the Eileen Skellern Lecture can be found here: http://www.winship.info/skellern

  City University London is a principal provider of undergraduate, postgraduate, professional and vocational education in the United Kingdom. The University is committed to leading London in education, research and knowledge transfer for businesses and the professions and is renowned for its international focus and the employability of its graduates.

  The University teaches across a range of subjects in arts including journalism and music, informatics, social sciences, engineering and mathematical sciences, business, law, health and community sciences.

  The University attracts over 23,000 students from 156 countries, while teaching staff are drawn from nearly 50 international locations, ensuring that the University has a truly international outlook.

  City University London was founded in 1894 as the Northampton Institute and was awarded full university status in 1966. Please see the following link for more information www.city.ac.uk

  Helena Clay
Press Officer
City University London
Northampton Square
London, EC1V OHB
United Kingdom

T    +44 (0)20 7040 8788
M   +44 (0)7970 271 260
F    +44 (0)20 7040 5555
W   www.city.ac.uk  


This year's Eileen Skellern Event takes place at the London South Bank University, Keyworth Events Theatre, Keyworth Street, SE1 6NG (nearest tube: Elephant & Castle Bakerloo Line – see; http://www.lsbu.ac.uk/about/maps.shtm) on Tuesday Dec 2nd , 6-9.30pm.

Proceedings for the evening are as follows:

6.00 Guests arrive

6.25 Chair: Dr Joy Bray

6.30 Welcome – Professor David Sines

6.35 Mental Health Practice Innovation Award 2008: Introduced by Ian Mcmillan

Recipient: Paul Lefever

6.50 Skellern Memorial lecture 2008: Professor Len Bowers (introduced by Joy Bray)

7.30 Respondent: Professor Cheryl Forchuk

Plaque presented by: Mrs Elizabeth Beattie (Eileen’s sister).

7.45 Buffet & Wine reception

8.30 JPMHN Lifetime Achievement Award 2008: Professor Bryn Davis (introduction: Dawn Freshwater). Presentation of Plaque: TBC

9.15 Vote of thanks - Gary Winship

9.20 Finish

Sponsored by:

South London & Maudsley NHS Trust, South West London & St Georges Mental Health Trust, Birmingham & Solihull Mental Health Trust, Journal of Psychiatric & Mental Health Nursing, Mental Health Practice, London South Bank University.


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