The Lovisenberg Open Acute Door Study (LOADS)

Summary

Unnecessary coercion can cause patients to lose hope and undermine their engagement in treatment. The Lovisenberg Open Acute Door Study (LOADS) aims to reduce unnecessary coercion in acute psychiatric wards at the Lovisenberg Diaconal Hospital in Oslo, Norway by implementing a new service model, ‘open door policy’. In open-door policy, the main door to the acute ward is open by default to prevent tension among admitted patients. The open door also enables patients to remove themselves from provoking situations that could have resulted in violence. One aim of LOADS is to enhance trust in the health services and counteract the image of acute mental health care as synonymous with coercion. Staff in LOADS will be trained in finding alternatives to coercion while continuously assessing the safety of each patient.

LOADS will start by developing a version of open-door policy adapted to Lovisenberg’s setting: acutely admitted patients with serious mental health problems living in the inner-city boroughs of Oslo, Norway. Development is based on experiences at hospitals in Germany and Switzerland, as well as input from patients and staff at Lovisenberg. The open-door policy will affect both how we work with patients at the hospital, how we train to maintain and improve staff’s coercion prevention skills, and how patients engage with outpatient services before and after admission. After development is finished, two acute psychiatric departments will apply the open-door policy for one year.

After 12 months, LOADS will evaluate satisfaction and use of coercion in the open-door policy wards compared to 'best practice' wards. If the evaluation shows open-door policy to be no worse than the current locked-ward model, additional wards will start implementing open-door policy. Evaluation and development will continue for a further three years focusing on coercive measures, violent events, patient experiences, in-house drug use, and comparison with neighboring hospitals.

The results from the study was published in The Lancet Psychiatry in March 2024: 

A. Indregard, H. M. Nussle, M. Hagen, P. O.Vandvik, M. Tesli, J. Gather, N. Kunøe, Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway, The Lancet Psychiatry 2024 (Free access until April 25)

Media

Tvangsinnlagte har åpne dører - NRK Dagsrevyen 1.4.2024

Tvang i psykiatrien bryter menneskerettigheter - NRK Radio 2.4.2024

Project members:

Nikolaj Kunøe, Principal Investigator (nku@lds.no)

Anne Marthe Rustad Indregard Post Doctoral Research Fellow (anmain@oslomet.no)

Hans Martin Nussle Special Advisor (hmnu@lds.no)