Number of Seclusions in the Netherlands Higher in the 7 Years Since the End of a Nationwide Seclusion-Reduction Program

Vruwink, Fleur J.; Wierdsma, André I.; Noorthoorn, Eric; Nijman, Henk; Mulder, Cornelis L.

doi:10.3389/fpsyt.2021.778793

Cited by 9 publications

(5 citation statements)

References 21 publications

(30 reference statements)

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“…At a national level, seclusion in 2019 was still an important measure that was still being used more often than other coercive measures. And the total number of seclusions at a national level was in this year largely the same as at the end of the seclusion-reduction programs in 2012 (64). Our findings are thus likely to retain their clinical validity.…”

Section: Strengths and Limitationssupporting

confidence: 51%

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

et al. 2022

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ObjectiveIn the Netherlands, seclusion of patients with a psychiatric disorder is a last-resort measure to be used only in the event of (imminent) severe danger or harm. Although aggressive behavior is often involved, seclusions not preceded by aggression also seem to occur. We sought insight into the non-aggressive reasons underlying seclusion and investigated the factors associated with it.MethodWe included all patients admitted to a Dutch psychiatric hospital in 2008 and 2009. Seclusions had been registered on Argus-forms, and aggression incidents had been registered on the Staff Observation Aggression Scale-Revised (SOAS-R), inspectorate forms and/or patient files. Determinants of seclusion with vs. without prior aggression were analyzed using logistic regression. Reasons for seclusion without prior aggression were evaluated qualitatively and grouped into main themes.ResultsOf 1,106 admitted patients, 184 (17%) were secluded at some time during admission. Twenty-one (11.4%) were excluded because information on their seclusion was lacking. In 23 cases (14%), neither SOAS-R, inspectorate forms nor individual patient files indicated any aggression. Univariable and multivariable regression both showed seclusion without preceding aggression to be negatively associated with daytime and the first day of hospitalization. In other words, seclusion related to aggression occurred more on the first day, and during daytime, while seclusion for non-aggressive reasons occurred relatively more after the first day, and during nighttime. Our qualitative findings showed two main themes of non-aggressive reasons for seclusion: “disruptive behavior” and “beneficial to patient.”ConclusionAwareness of the different reasons for seclusion may improve interventions on reducing its use. Thorough examination of different sources showed that few seclusions had not been preceded by aggression. The use of seclusion would be considerably reduced through interventions that prevent aggression or handle aggression incidents in other ways than seclusion. However, attention should also be paid to the remaining reasons for seclusion, such as handling disruptive behavior and focusing on the beneficial effects of reduced stimuli. Future research on interventions to reduce the use of seclusion should not only aim to reduce seclusion but should also establish whether seclusions preceded by aggression decrease different from seclusions that are not preceded by aggression.

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Section: Strengths and Limitationssupporting

confidence: 51%

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

et al. 2022

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“…Overseas studies indicate that initial reductions in restraint use were not sustained when funding for initiatives to reduce restraint practices was withdrawn (Valimaki et al 2019;Vruwink et al 2021). It is clear that in addition to funding, there is a need for 'strong clinical leadership, trained and experienced staff, adequate staffing levels, and staff-consumer rapport' to ensure sustained reductions in restrictive practices (Australian College of Mental Health Nurses 2017; p. 9).…”

Section: Discussionmentioning

confidence: 99%

“…2019; Vruwink et al . 2021). It is clear that in addition to funding, there is a need for ‘strong clinical leadership, trained and experienced staff, adequate staffing levels, and staff‐consumer rapport’ to ensure sustained reductions in restrictive practices (Australian College of Mental Health Nurses 2017; p. 9).…”

Section: Discussionmentioning

confidence: 99%

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint

Meehan

McGovern

Kinery

et al. 2022

Int J Mental Health Nurs

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Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone (‘face down’) restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular.

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“…All countries except The Netherlands had individual country profiles in the 2020 WHO Mental Health Atlas. The Netherlands’ most recent nationwide report was for 2014, although a recent study, 26 together with updated general data gathered from mental health inspectorate sources such as the Dutch National Institute for Public Health and the Environment, suggested that the 2014 data continued to reflect current daily practice, warranting inclusion in the current study. Several other countries reported on different aspects of mental healthcare in 2020 compared with 2017.…”

Section: Methodsmentioning

confidence: 97%

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies

Savage,

Lepping,

Newton-Howes

et al. 2024

BJPsych open

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Background Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. Aims We determined rates of coercive practices and compared them across countries. Method We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports. Results The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints. Conclusions We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.

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Number of Seclusions in the Netherlands Higher in the 7 Years Since the End of a Nationwide Seclusion-Reduction Program

Cited by 9 publications

References 21 publications

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

“Disruptive Behavior” or “Expected Benefit” Are Rationales of Seclusion Without Prior Aggression

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies

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