The use of seclusion in the Netherlands compared to countries in and outside Europe

Janssen, W; Noorthoorn, Eric; Vries, W.J. de; Hutschemeakers, G.J.M.; Lendemeijer, H. H. G. M.; Widdershoven, Guy

doi:10.1016/j.ijlp.2008.09.002

Cited by 69 publications

(76 citation statements)

References 18 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2004, a study performed in 12 hospitals showed that 60% of the measures taken were not reported to the Health inspectorate. Also, approximately 27% of patients on admission wards were subjected to seclusion and the duration was estimated 250 h per patient (26). This finding, presented in 2004, lead to a national uproar.…”

Section: Seclusionmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

View full text Add to dashboard Cite

In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.

show abstract

Section: Seclusionmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Despite the controversy, seclusion continues to be a commonly used intervention in Dutch psychiatric wards, while no scientific evidence is available for the therapeutic effects of its use [5, 6]. Although it is difficult to find reliable data of seclusion rates in the Netherlands, on average, still one in four hospitalized patients will experience a seclusion episode [7]. Furthermore, a study evaluating different European cultures and perspectives toward the use of seclusion showed that Dutch professionals, compared to those in Finland and the UK, are less in favour of using seclusion than their colleagues in Finland, but more than their colleagues in the UK [8].…”

Section: Introductionmentioning

confidence: 99%

Professionals’ Attitudes After a Seclusion Reduction Program: Anything Changed?

et al. 2012

View full text Add to dashboard Cite

Changing professionals’ attitudes toward seclusion is seen as an important condition to reduce its use. The purpose of this study was to determine whether professionals from a mental health institute in the Netherlands changed in their attitudes toward seclusion after implementation of a multifaceted seclusion reduction program. Professionals working on four acute admission wards filled in the Professional Attitudes Toward Seclusion Questionnaire (PATS-Q) before and after a seclusion reduction program. Changes were analyzed by comparing mean scores on the PATS-Q. After the program, professionals scored significantly higher on ‘ethics’ and ‘more care’. As expected, no change occurred on ‘reasons’ for the use of seclusion. In addition, no significant changes were found on ‘confidence’, ‘better care’ and ‘other care’. Significant changes in professional attitudes concerning the ethics of using seclusion and involving issues of more care were observed after a seclusion reduction program. Mental health professionals moved in the direction of ‘transformers’, indicating an increased criticism of the practice of seclusion and increased willingness to change their own use of seclusion.

show abstract

“…The use of seclusion and involuntary medication may have been underreported to the DHCI [2], especially before 2006. Better registration after 2006, however, would mean that the results of the nationwide program have been underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…In the Netherlands, it is seclusion. This partly explains why the use of seclusion is much higher in the Netherlands than in surrounding countries [2,3]. To fund a nationwide program to reduce seclusion by 10% per year, the Dutch government therefore provided €5 m annually from 2006 to 2009 [4].…”

Section: Introductionmentioning

confidence: 99%

The effects of a nationwide program to reduce seclusion in the Netherlands

Vruwink

Mulder²,

Noorthoorn

et al. 2012

BMC Psychiatry

View full text Add to dashboard Cite

BackgroundFrom 2006 to 2009, the Dutch government provided €5 m annually for a nationwide program to reduce seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both seclusion and involuntary medication changed significantly after the start of this national program.MethodsUsing Poisson regression to estimate difference in logit slopes, we analyzed data for 1998–2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of seclusion and involuntary medication before and after the start of the program.ResultsThe difference in slopes of the numbers of seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002).ConclusionsAfter the start of the nationwide program the number of seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.

show abstract

The use of seclusion in the Netherlands compared to countries in and outside Europe

Cited by 69 publications

References 18 publications

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Professionals’ Attitudes After a Seclusion Reduction Program: Anything Changed?

The effects of a nationwide program to reduce seclusion in the Netherlands

Contact Info

Product

Resources

About