I think patient dignity has a high value here...this is psych, after all. There is just no medical need for a patient to remain gowned. I cannot imagine denying a patient the right to wear pants or long sleeves, on the off chance they are a crafty self-harmer. It's more of a safety risk to allow them to wander around wrapped in blankets if they are cold, and it's cruel to make someone freeze just for easier access for staff to view arms. A dedicated self harmer would just switch from the forearms and cut somewhere less visible. Scrubs would be a better option if you had a seriously dedicated self-harmer that you had to relegate to institution clothing. Good visual access without feeling as institutionalized.
Over a decade ago, I was in a psych ward after a suicide attempt. Gowns did feel humiliating; it's hard to explain unless you have been there. There was no safety reason for me to be in a gown and I felt so much more like a human when my family brought in street clothing. That facility didn't allow underwire bras, so I was wandering around with huge, flappy breasts in a gown for all to see my glory, double gowned, and still feeling massively exposed. My street clothing with a sports bra felt like heaven. It sounds silly, but that was a big reason I isolated in my room to begin with...I felt so exposed and uncomfortable out of my room dressed like that. I got clothing and then I came out of my room.
I would rather focus on removing environmental issues where patients self harm on these things and correct those. For example, we have no call bells. We also do medical psych, and for bedbound patients or patients with mobility issues, we put a small silver bell on a bedside table for them to ding. There are fire-alarm style wall pulls in the bathroom for safety (no cords). Otherwise, they are healthy and ambulatory, so no need for a call bell.
We had a cutter use her institution hair comb to cut...we still quickly found out and she lost her comb. She took her roomate's, so she got put in a single and blocked and we tossed her her room for any other unlikely risks. She even lost her arm band for cutting with that. Remove the environmental problems, don't strip the patient. She eventually started head banging. She got a sitter. Better environmental care is what she needed, and solid and quality safety checks...not to be stripped and placed in a gown.
Our medical beds have super short cords and adapted side rails, and nursing needs a key to adjust the height of the bed or the head or foot angles, so there is no ligature risk. If a patient is medically ill enough to need a true medical bed, an air bed, or a bariatric bed, they are blocked and made a single, so ambulatory patients cannot get to the cord. If they manage to still be a self harm risk, they get a one on one sitter, or a line of sight. Patients on O2 are also singled and use a heavy O2 concentrator, so no wall access to cut themselves on or to potentially hang on.
In psych, dignity is often stripped, and loss of dignity can be traumatic to patients. This is DIRECTLY related to their care plan. As a former psych patient, I felt like I was a prisoner when I was in institution attire. I just did.
In psych, we have no business making new trauma. And believe me, being braless in a large, flapping institution gown felt like a small trauma to me, as a victim of sexual assault. I felt...exposed. Wearing gowns only has quite the institutionalized feel to it. You don't need gowns; you need stronger search policies for clothing prior to wear, a solid dress code and hygiene policy, and better environmental safety.
And for heaven sake, if staff is supervising the laundry, it is entirely their fault for ruining clothing! That takes some top notch skill. If it looks fancy, read the tag. Ask if its washer safe. Don't wash leather or wool. We don't do fabric softener, just fragrance free laundry detergent pods. Pop two in, put in clothes, hit button, you're done. We only wash it if the patient asks. So we make them understand if they want it washed and it shrinks, their fault. It is part of our psych unit consent that they sign that if something messes in the laundry and they asked for it to be washed, it's on them. If they didn't ask for it to be washed, but we washed it...and it gets ruined...that's on us. Still, if something truly gets screwed up and it is on us, then yes, our Director will reimburse them. Rarely happens. If they stink, we offer to wash. If they refuse, well, yes, we have blocked patients into a single for poor hygiene. Can't force them to shower or wear clean clothing.
As for bed bugs or lice, the facility needs to have infection control institute a bed bug or mite policy. We make bed bug infested clothing be double bagged, placed in a large sealed storage bin, and stored by EVS. The patients have to be decontaminated per policy with special pharmacy ordered washes and rinses. Those patients then must either wear gowns or have family bring in non-infested clothing that is not from the infested dwelling...or we set them up with a couple outfits from the charity "clothing closet". We never launder those items because regular washers don't get hot enough to kill the buggers...and bed bugs and lice ARE a health and safety issue, so that trumps everything else.
The off chance that someone might get extra crafty and self harm is not a high enough risk to warrant a widespread gowning policy. By all means, no strings, no provocative or exposing clothing, no belts, no hoodies, no clunky shoes or laces, nothing that is a fall risk...heck, I've even worked places where we don't allow underwire bras to prevent poking out the wires and self harming. Those are reasonable. But I have no need for full time unfettered access to a patient's body like a medical patient would need...unless our patient is incontinent and bed bound, then yes, we gown them in their rooms. But if they have clothing and we can put on a brief, place them in a recliner and wheel them out on the milieu, then yes, we will street clothes them up.
Yes, I feel pretty strongly about this. Clothing should be allowed. Sounds like your facility needs a much better environmental safety and some rudimentary lessons on how to launder clothing for the staff.
The only time we "made" a patient not wear street clothes, it was because she was bedbound and on hemodialysis...with a subclavian dialysis line dangling out of her chest (visually looks like a double lumen Broviac line with a standard central line dressing), IV fluids because she was catatonic and not drinking or eating, and incontinent. She got a medical air bed and was on 02 as well. She also had a little silver call bell, not that she used it when in catatonia. She was with us for ECT and IM Ativan therapy.
Those are just my thoughts.