Abstract
BackgroundOn January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) replaced the Special Admissions Act (BOPZ). While the old law only allowed compulsory treatment in hospitals, the new law allows it both inside and outside the hospital. Moreover, the new law prioritizes the patient's own opinion on coercive measures. By following patients' own choices, the Compulsory Care Act is hoped to lead to fewer admission days and less inpatient compulsory treatment in involuntarily admitted patients.MethodsWe studied the seclusion and enforced-medication events before and after January 1, 2020, using coercive measures monitoring data in a Mental Health Trust. Trends in hours of seclusion and the number of enforced-medication events per month from 2012 to 2019 were compared with 2020. We used generalized linear models to perform time series analysis. Logistic regression analyses and generalized linear models were performed to investigate whether patient compilation determined some of the observed changes in seclusion use or enforced-medication events.ResultsThe mean number of hours of seclusion between 2012 and 2019 was 27,124 per year, decreasing from 48,542 in 2012 to 21,133 in 2019 to 3,844 h in 2020. The mean incidence of enforced-medication events between 2012 and 2019 was 167, increasing from 90 in 2012 to 361 in 2019 and then fell to 294 in 2020. In 2020, we observed 3,844 h of seclusion and 294 enforced-medication events. Near to no outpatient coercion was reported, even though it was warranted. The time series analysis showed a significant effect of the year 2020 on seclusion hours (β = −1.867; Exp(β) = 0.155, Wald = 27.22, p = 0.001), but not on enforced-medication events [β = 0.48; Exp(β) = 1.616, Wald = 2.33, p = 0.13].DiscussionThere was a reduction in the number of seclusion hours after the introduction of the Compulsory Care Act. The number of enforced-medication events also increased from a very low baseline, but from 2017 onwards. To see whether these findings are consistent over time, they need to be replicated in the near future.ConclusionWe observed a significant increase in enforced-medication use and a decrease in seclusion hours. The year 2020 predicted seclusion hours, but not enforced-medication events.
Highlights
On January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) (2020) [1] replaced the Special Admissions Act (1994) (BOPZ) [2]
The time series analysis showed a significant effect of the year 2020 on seclusion hours (β = −1.867; Exp(β) = 0.155, Wald = 27.22, p = 0.001), but not on enforced-medication events [β = 0.48; Exp(β) = 1.616, Wald = 2.33, p = 0.13]
An important motivation for the new law was the assumption that a community treatment order (CTO) will lead to fewer admission days and fewer inpatient coercive measures such as seclusion or enforced medication in patients who are involuntarily admitted [3, 5]
Summary
On January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) (2020) [1] replaced the Special Admissions Act (1994) (BOPZ) [2]. Conditional authorization was introduced [3] This allowed the possibility of outpatient treatment with conditions. The second evaluation concluded that the law was too much focused on patients’ rights and too little on treatment. While the Special Admissions Act only allowed compulsory treatment in emergency situations in hospitals, the new act allows compulsory treatment in both inpatient and outpatient settings. An important motivation for the new law was the assumption that a CTO will lead to fewer admission days and fewer inpatient coercive measures such as seclusion or enforced medication in patients who are involuntarily admitted [3, 5]. By following patients’ own choices, the Compulsory Care Act is hoped to lead to fewer admission days and less inpatient compulsory treatment in involuntarily admitted patients
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