An Open Psychiatric Treatment Setting with Respect for Patient Authority
Austen Riggs held a blog competition among staff members where we asked them to answer the question: “What does the open setting mean to you?” Elizabeth Weinberg, MD, Staff Psychiatrist, wrote the blog entry below.
When clinical staff at Austen Riggs talk about "the open setting," we are invoking a concept intimately familiar to those of us, both patients and staff, who have been here for any significant period of time. What we mean by this term, however, is not always immediately obvious outside this system. In the world of psychiatric treatment settings, an "open setting" can be almost anything other than a locked unit, and usually isn't the focus of much internal debate. At Riggs, the open setting is much more than an unlocked unit, and is constantly undergoing examination, questioning and revision.
Inherent in our concept of the open setting is a position of radical respect for patient authority and autonomy. The guiding point of view at the Austen Riggs Center is that the patient fundamentally is in charge of her treatment, no matter how out of control the patient's internal experience or observed behavior might appear. Patients benefit from experiencing their difficulties in an environment where they can work with others to observe them, learn about them, and decide for themselves how, what and if they wish to change. This leads to the development of a treatment quite different from those that most patients have experienced. It is expected that patients here take treatment seriously, but the forms treatment can take are individualized and various.
Terms such as "freedom" and "autonomy" are, however, abstract. The actual meaning of the open setting lies in the day-to-day way we work out the particulars of treatment with each other. Clear guidelines are necessary for patients to feel safe and focused enough to work. It is in the ongoing process of revisiting and reworking the daily tasks of patient care that the meaning of "open setting" ultimately lies.