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Open Access Research article

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

Fleur J Vruwink1*, Cornelis L Mulder23, Eric O Noorthoorn4, Daan Uitenbroek5 and Henk LI Nijman67

Author Affiliations

1 GGNet, PO Box 2003, 7230 GC, Warnsveld, the Netherlands

2 Public Mental Health, Research Center O3, Erasmus MC, Rotterdam, the Netherlands

3 Bavo Europoort, Mental Health Center Rotterdam, Prins Constantijnweg 48-54, 3066 TA, Rotterdam, the Netherlands

4 GGNet, Bestuursbureau, PO Box 2003, 7230 GC, Warnsveld, the Netherlands

5 Quantitative Skills, Consultancy for Research and Statistics, Lieven de Keylaan 7, 1222 LC, Hilversum, The Netherlands

6 Forensic psychology, Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands

7 Altrecht Aventurijn, Dolderseweg 164, 3734 BN, Den Dolder, the Netherlands

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BMC Psychiatry 2012, 12:231  doi:10.1186/1471-244X-12-231

Published: 18 December 2012

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.

Keywords:
Seclusion; Restraint; Coercive measures; Reduction; Nationwide effort