Open-Door Policy in Psychiatry: Effects and Paradoxes

Aims. - Via a brief history of Open-Door Policy (ODP) in psychia-try, 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 psy-chiatry 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 moda-lities 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.(c) 2023 Elsevier Masson SAS. All rights reserved.