Abstract
Introduction: Between 2006 and 2012 the Dutch government funded a nationwide program for reducing the use of seclusion. Although an initial first trend study showed that the reported number of seclusions declined during the program, the objective of a 10% annual decrease was not met. We wished to establish whether the decline had continued after funding ended in 2012.Method: Using quasi Poisson time series modeling, we retrospectively analyzed the nationally reported numbers of seclusion and involuntary medication between 1998 and 2019, i.e., before, during and after the end of the nationwide program, with and without correction for the number of involuntary admissions.Results: With and without correction for the number of involuntary admissions, there were more seclusions in the seven years after the nationwide program than during the nationwide program. Although the reported number of involuntary medications also increased, the rate of increase was slower after the end of the nationwide program than before.Conclusions: Rather than continuing to decrease after the end of the nationwide program, the number of seclusions rose. This may mean that interventions intended to reduce the use of seclusion within this program are not properly sustained in daily clinical care without an ongoing national program.
Highlights
Between 2006 and 2012 the Dutch government funded a nationwide program for reducing the use of seclusion
The start of either of these two ways of coercive measures has to be reported to the Dutch Health Care Inspectorate (DHCI), which published the annual numbers of notifications of seclusion and involuntary medication from 1998 until 2019
The overall number of seclusions decreased during the nationwide program, the number of seclusions increased by 5.7% in the seven years after the end of the program
Summary
Between 2006 and 2012 the Dutch government funded a nationwide program for reducing the use of seclusion. If other interventions in psychiatry fail, in many countries seclusion and restraint are often used as a last resort to manage disruptive and violent behaviors Though both may prevent injury to the patient, others, or property, they have negative side effects for patients and staff. The individual hospitals were free to choose an intervention to reduce the use of seclusion, leading to a wide range of new care methods to reduce the use of seclusion These methods were for example structured risk assessment, feedback of data on coercive measures, deescalation training, trauma-informed care, increasing hospitality, but could mean a changed building layout, like single-person bedrooms, comfort rooms, low-threshold access to nurses in the ward or at counters rather than in nurse stations [12, 13]. The number of seclusions and their durations both decreased [12]
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