Between freedom and confinement: social control and community dynamics in an open prolonged psychiatric hospitalization ward for traumatized women

This study examines the dynamics of social control within ‘By Your Side’, an open psychiatric ward at Merhavim Mental Health Centre in Be’er Ya’akov, Israel, which, despite its voluntary admission policy, exhibits features of a closed community. Drawing on criminological and therapeutic perspectives, the study explores how formal control, including institutional rules and professional oversight, and informal control, including peer norms and social sanctions, interact within this unique setting. Semi-structured interviews were conducted with 15 female inpatients with histories of trauma and eating disorders and 10 healthcare professionals. A thematic analysis identified seven central themes, including tensions between autonomy and confinement, the role of trauma in shaping relationships, subgroup formation, and the interplay between staff authority and peer regulation. The findings suggest that although voluntary admission fosters autonomy and readiness for change, the ward’s highly structured environment also reflects features of a total institution. The study highlights the complex relationship between therapeutic care and social control and considers implications for trauma-informed and gender-sensitive psychiatric treatment.