2. This introduction is about …
1. Seclusion in Dutch law.
2. The practice of seclusion, facts
and figures.
3. Policies to reduce the use of
seclusion.
STUIF
www.defredommissegroep.nl
3. Definition of Seclusion
(Lendemeijer & Shortridge-Bagget 1997)
Locking a patient alone in a room for:
* protection of the patient and his
environment;
* in order to control problem behaviour;
* to enable nursing care and treatment.
STUIF
www.defredommissegroep.nl
6. Characteristics of the law
Compared with international documents:
• The law has very strict criteria.
• Is basically an admission law. Forced
treatment of patients outside the hospital
is difficult to realize.
• No evaluation of forced treatment as a
regular procedure.
STUIF
www.defredommissegroep.nl
7. Seclusion in the law
• The use of seclusion is allowed in order to
avert danger for the patient or for others,
resulting from the psyciatric illness.
• Seclusion can be applied as part of an
agreed upon treatment program
(voluntarily) or forced (no agreement,
emergency or coercion).
STUIF
www.defredommissegroep.nl
8. 2. The practice of seclusion
On average:
- 27,5% of the patients, admitted to a
psychiatric hospital, is secluded;
- estimated 500 seclusion rooms/cells in the
Netherlands;
- estimated 18.000 seclusions every year.
STUIF
www.defredommissegroep.nl
9. International comparison
Number of separated patients per 1000 admissions (preliminary results
(Noorthoorn et al. 2008)
300
250
Australia
200 England
Finland
150
Germany
100 Netherlands
Switzerland
50
0
STUIF
www.defredommissegroep.nl
10. International comparison
preliminary results (Janssen et al. 2008)
Country Days in seclusion per 1000
nursing days
Belgium Average of 5
Netherlands Average 3,7
United States Between 4-110
STUIF
www.defredommissegroep.nl
11. Conclusion
In the Netherlands patients are secluded
more often than in other countries but the
seclusions do not evidently last longer
than in other countries.
STUIF
www.defredommissegroep.nl
12. Predictors of seclusion
• Age;
• Disorder on axis 1(bipolar and psychotic
disorder) and axis 5 (level of functioning);
• Duration of admittance (longer, more chance);
• Days after admittance (shorter, more chance).
• Estimate of 50% of seclusions are preceded by
agression incidents and vice versa (50% of the
agression incidents are followed by a seclusion).
STUIF
www.defredommissegroep.nl
13. BUT!!!!
• Differences in numbers of seclusion
between hospitals in the Netherlands are
large.
• Registration is not very reliable yet.
• Comparison is difficult (registration base is
sometimes a ward, sometimes a hospital).
• Estimated 30-40% of all the freedom
limiting measures is registered
(Landeweer et al, 2007).
STUIF
www.defredommissegroep.nl
14. 3. Policies to reduce the use of
seclusion and restraint
POLICY STAGES
I. Before 2002 no policy
II. 2002-2004 Moving the field (12 projects)
III. 2004-2008 Spreading best practice nation wide (42
projects)
STUIF
www.defredommissegroep.nl
15. What do these 42 projects do?
• The advancement of competence and expertise.
• Changing wards cultures (welcoming policies,
develop alternatives for seclusion).
• Prevention
• Intensify dialogue with clients about treatment.
• Improve registration.
STUIF
www.defredommissegroep.nl
