Trapped. This single word describes the feeling that came to me from each of my adolescent hospitalizations. The double doors, separated with a buzzer to keep us from escaping, gave a feeling of being caged while the 15-minute "checks" disrupted my sleep and augmented my sense of paranoia at the time. An opportunity for treatment in a hospital has the potential to be as liberating as it is confining, opening necessary exploration into one's mental health treatment and vital referrals.

Yet, as a teen then and now as an adult clinician, I wonder: Is all of this control done in the name of safety necessary? Is it harmful?

Inpatient psychiatric treatment is often utilized to address immediate mental health concerns ranging from psychosis to self-harm. The most common reason for psychiatric hospitalization is thoughts of suicide and suicide attempts. Within psychiatric inpatient treatment settings, it is usual practice for any personal belongings that could be used to harm one's self to be removed, and visiting and phone calls are restricted. 15-minute "checks" involving a staff member having a person in their line of sight every 15 minutes, even through the night, are also sometimes used.

This level of 'security' measures that are traditional in inpatient units in the United States is beyond that within the psychiatric units of many other countries. In the borders of many European countries, for example, open units where individuals can come and go are common. Even when the hospitalization is "involuntary" on an open unit a person still may have grounds privileges of being able to leave campus. If they do not return, authorities may be notified, however, the level of restriction overall is markedly less (Efkemann et al., 2019). A study comparing patient satisfaction and perception of safety among individuals hospitalized with an 'involuntary' status (the hospitalization was mandated) in Germany found that those in open units felt safer than those in locked ones (Efkemann et al., 2019).

Due to the workforce necessary to meet the 24-hour demands of a psychiatric unit, understaffing is a common concern. Yet, interestingly, one study found........

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