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

Kenniscentrum GGNet, Warnsveld, The Netherlands.
International Journal of Law and Psychiatry (Impact Factor: 1.19). 01/2009; 31(6):463-70. DOI: 10.1016/j.ijlp.2008.09.002
Source: PubMed


The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as other countries in and outside Europe. The aim of this study is to describe Dutch seclusion data and compare these with data on other countries, derived from the literature. An extensive search revealed only 11 articles containing seclusion rates of regions or whole countries either in Europe, Australia or the United States. Dutch seclusion rates were calculated from a governmental database and from a database covering twelve General Psychiatric Hospitals in the Netherlands. According to the hospitals database, on average one in four hospitalized patients experienced a seclusion episode. The mean duration according to the governmental database is a staggering 16 days. Both numbers seem much higher than comparable numbers in other countries. However, different definitions, inconsistent methods of registration, different methods of data collection and an inconsistent expression of the seclusion use in rates limit comparisons of the rates found in the reviewed studies with the data gathered in the current study. Suggestions are made to improve data collection, to enable better comparisons.

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    • "Kaltiala-Heino, Tuohimäki, Korkeila, and Lehtinen (2003) found violence as a reason for seclusion is associated with chronic situations and organic disorders, so the result does not support that seclusion is needed in the treatment of actually admitted violent patients in psychiatric settings. According to Janssen, et al ( 2008) many of opinions of many Dutch psychiatrists, nurses and policy makers seclusion of patients is an old fashioned unethical intervention. "
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    ABSTRACT: Aim: This essay is aimed at providing a comprehensive overview regarding the use of seclusion among psychiatric inpatients in addition to focusing on controversial opinions of this debate.
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    • "The widespread use of seclusion in psychiatric facilities to manage imminent violence has been the focus of international concern and has forced hospitals to search for alternatives (Huckshorn 2004; Huckshorn & LeBel 2009; Paterson & Duxbury 2007; Sailas & Fenton 2000; Whittington et al. 2006). In the Netherlands, seclusion is still a frequently-used intervention (Janssen et al. 2008). Seclusion is defined as the enclosure of a patient in a special bare room, which has been approved for this purpose by the government, with the door locked (GGZ Nederland 2012, p. 19). "
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    ABSTRACT: Patient care in a psychiatric setting can benefit from a more systematic, transparent, and goal-driven way of working. The methodical work approach, with its cyclic five phases, provides such an approach: (i) translation of problems into goals; (ii) search for means to realize the goals; (iii) formulation of an individualized plan; (iv) implementation of the plan; and (v) evaluation and readjustment. We examined the effect of the methodical work approach on the use of seclusion at a ward for the intensive treatment of inpatients with psychoses and substance-use disorders. The team of this ward implemented the methodical work approach. Special attention was paid to the involvement of the patient and his/her family in the treatment process and to the role of the coordinating nurse. Compared to control wards within the same hospital, at the ward where the methodical work approach was implemented, a more pronounced reduction was achieved in the number of incidents and in the total hours of seclusion. Implementation of the methodical work approach can contribute to a reduction in the use of seclusion.
    International journal of mental health nursing 07/2013; 23(2). DOI:10.1111/inm.12037 · 1.95 Impact Factor
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    • "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]. "
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    ABSTRACT: Background From 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. Methods Using 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. Results The 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). Conclusions After 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.
    BMC Psychiatry 12/2012; 12(1):231. DOI:10.1186/1471-244X-12-231 · 2.21 Impact Factor
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