The Austen Riggs Center is a unique treatment setting because of its emphasis on intensive individual psychoanalytic psychotherapy in a therapeutic community and its fully open setting. Our orientation and philosophy are based on working collaboratively with individuals with complex psychiatric issues whom we nevertheless consider ultimately responsible for their own lives and safety. We do not coerce patients to behave in any particular way and do not compel participation in any part of the treatment program, always seeing it as a patient’s responsibility to discover his or her own motivation. Those who have accepted an offer of admission, and their families, have decided that the opportunities for change inherent in our treatment program outweigh the risks of an open, nonrestrictive environment.
The human rights of a patient at the Austen Riggs Center are the same as those of a citizen of the United States. There are no privileges to earn, and there is no forfeiture of freedom. There are, however, responsibilities and risks assumed by patients and their families when admission to the Center is accepted. Except in brief emergency situations, we are not able to put a patient on suicidal precautions, nor do we confine him or her to a seclusion room or even to the grounds of the hospital. We do not use restraints and do not medicate patients against their will. Ultimately, the patient is responsible for maintaining behavior in keeping with the demands of an open hospital. This is significantly different from the situation in closed hospitals. If, during the course of treatment, a patient enters a period of unacceptably high suicidal or homicidal risk or significant substance abuse, transfer to a closed setting may be appropriate in order to protect the patient. Patients and their families have a responsibility to inform the Center of concerns they may have about a patient’s safety. In an open setting, the benefits of obtaining treatment while maintaining one’s freedom, integrity and autonomy must constantly be weighted against the risks and responsibilities.