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Seclusion and enforced medication in dealing with aggression: A prospective dynamic cohort study

Published online by Cambridge University Press:  23 March 2020

A.A. Verlinde,
E.O. Noorthoorn,
W. Snelleman,
H. van den Berg,
M. Snelleman – van der Plas and
P. Lepping
A.A. Verlinde
Affiliation:
Mediant mental health trust, 1050 7546 TA Broekheurnering, The Netherlands
E.O. Noorthoorn*
Affiliation:
Forensic ward and long stay ward, Ggnet mental health trust 12, Vordenseweg, 7231DA Warnsveld, The NetherlandsVU medical centre, Amsterdam, The NetherlandsDutch information centre of coercive measures, Bilthoven, The Netherlands
W. Snelleman
Affiliation:
Mediant mental health trust, 1050 7546 TA Broekheurnering, The Netherlands
H. van den Berg
Affiliation:
Mediant mental health trust, 1050 7546 TA Broekheurnering, The Netherlands
M. Snelleman – van der Plas
Affiliation:
Forensic ward and long stay ward, Ggnet mental health trust 12, Vordenseweg, 7231DA Warnsveld, The Netherlands
P. Lepping
Affiliation:
Wrexham community mental health team, Betsi Cadwaladr university health board, Ty Derbyn, Wrexham Maelor hospital, Wrexham, Wales, United KingdomCentre for mental health and society Bangor university, Bangor, county of Gwynedd North Wales, United KingdomMysore medical college and research institute, Mysore, India
*
* Corresponding author. Forensic ward and long stay ward, Ggnet mental health trust, 12, Vordenseweg, 7231 DA Warnsveld, The Netherlands. E-mail addresses:Enoorthoorn@hotmail.com, e.noorthoorn@ggnet.nl (E.O. Noorthoorn).
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Abstract

Background

In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.

Methods

The study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.

Results

Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.

Conclusions

When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.

Keywords

ViolenceEmergencyQuality of careLaw ethics and human rights

Information

Type
Original article
Information
European Psychiatry , Volume 39 , January 2017, pp. 86 - 92
Copyright
Copyright © Elsevier Masson SAS 2017

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References

Vruwink, FJMulder, CLNoorthoorn, EOUitenbroek, DNijman, HLIThe effects of a nationwide program to reduce seclusion in the Netherlands. BMC Psychiatry 2012; 12: 231–232.CrossRefGoogle ScholarPubMed
Legemaate, JFreriks, BJMRoode, RPInternationale ontwikkelingen. In: Derde evaluatie BOPZ, EMOG/VUMC. Maart; 2007.Google Scholar
Janssen, WANoorthoorn, EODe Vries, WJHutschemaekers, GJLendemeijer, HHGMWiddershoven, GAMThe use of seclusion in the Netherlands compared to countries in and outside Europe. Int J Law Psychiatry 2009; 31(6): 463–470.CrossRefGoogle Scholar
Janssen, WANoorthoorn, EONijman, HLIBowers, LHoogendoorn, AWSmit, Aet al.Differences in seclusion rates between admission wards: does patient compilation explain?. Psychiatr Serv 2012. http://dx.doi.org/10.1007/s11126-012-92253.CrossRefGoogle Scholar
Vrijlandt, AJVan alle tijden en toch uniek Nederland: Landelijke Nieuwsbrief Dwang & Drang GGz; 2002. p. 1–2.Google Scholar
Schippers EI. 12 juli 2012 brief CZ – 3121711. Stand van zaken brief naar aanleiding van AO overleg dwang en drang.Google Scholar
Georgieva, IMulder, CLWierdsma, A Patients’ preference and experiences of forced medication and seclusion. Psychiatr Quart 2011. http://dx.doi.org/10.1007/s11126-011-9178-y.CrossRefGoogle Scholar
Méndez, JE Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. UN report A/HRC/22/53 2013Google Scholar
Richtlijn Dwang, Nederlandse Vereniging Voor Psychiatrie [Guideline Coercion Dutch Association of Psychiatry], 2007.Google Scholar
Janssen, WAVan de Sande, RNoorthoorn, EONijman, HLIBowers, LMulder, CLMethodological issues in monitoring the use of coercive measures. Int J Law Psychiatry 2011; 34(6): 429–438.CrossRefGoogle ScholarPubMed
Veltkamp, ENijman, HStolker, JJFrigge, KDries, PBowers, LPatients’ preferences for seclusion or forced medication in acute psychiatric emergency in the Netherlands. Psychiatr Serv 2008; 59: 209–211.CrossRefGoogle ScholarPubMed
Stewart, DVan der Merwe, MBowers, LSimpson, AJones, A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues Mental Health Nurs 2010; 31: 413–424.CrossRefGoogle ScholarPubMed
Lepping, PMassood, BFlammer, ENoorthoorn, EO Comparison of restraint data from four countries. Soc Psychiatr Psychiatr Epidemiol 2016. http://dx.doi.org/10.007/s00127-16-1203-x [In press].Google Scholar
Noorthoorn, EOLepping, PJanssen, WAHoogendoorn, ANijman, HLIWiddershoven, GAMet al. One-year incidence and prevalence of seclusion: Dutch findings in an international perspective. Soc Psychiatry Psychiatr Epidemiol 2015. http://dx.doi.org/10.1007/s00127-015-1094-2 [Epub ahead of print].CrossRefGoogle Scholar
Noorthoorn, EOVoskes, YJanssen, WAMulder, CLvan de Sande, RNijman, HLIet al. Seclusion reduction in Dutch mental health care: did hospitals meet goals set?. Psychiatr Serv 2016 [appips201500414, epub ahead of print].CrossRefGoogle Scholar
Schaaf, Pvan der Dusseldorp, EKeuning, FMJanssen, WANoorthoorn, EO Impact of the physical environment of psychiatric wards on the use of seclusion. Br J Psychiatry 2013 [doi:10.1192].Google Scholar
Steinert, TLepping, PBernhardsgrütter, RConca, AHatling, TJanssen, WAet al.Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psychiatr Psychiatr Epidemiol 2010; 45: 889–897.CrossRefGoogle ScholarPubMed
Steinert, TMartin, VBaur, MBohnet, UGoebel, RHermelink, Get al.Diagnosis-related frequency of compulsory measures in German psychiatric hospitals and correlates with hospital characteristics. Soc Psychiatr Psychiatr Epidemiol 2007; 42: 140–145.CrossRefGoogle ScholarPubMed
Nijman, HPalmstierna, TMeasuring aggression with the staff observation aggression scale – revised. Acta Psychiatr Scand Suppl. 2002; 412: 101–102.CrossRefGoogle Scholar
Bak, Mvan Os, JMarcelis, MAcute medication perscription: a literature review and recommendations [Acute ingrijpmedicatie; literatuuroverzicht en aanbevelingen]. Tijdschrift Voor Psychiatr 2011; 10: 727–737.Google Scholar
Geneeskundige Inspectie voor de Geestelijke Volksgezondheid (GIGV). Wet bijzondere opnemingen in psychiatrische ziekenhuizen: BOPZ in de praktijk. [Dutch Mental health inspectorate, the law on special admissions in psychiatric hospitals in daily practice]. GIGV; Rijswijk 1994.Google Scholar
Flammer, ESteinert, TEisele, FBergk, JUhlmann, CWho is subjected to coercive measures as a psychiatric inpatient. A multi-level analysis. Clin Pract Epidemiol Mental Health 2013; 9: 110–119.CrossRefGoogle ScholarPubMed
Bowers, LThe expression and comparison of ward incident rates. Issues Mental Health Nurs 2000; 21(4): 365–374.CrossRefGoogle ScholarPubMed
Bowers, LBrennan, GFlood, CLipang, MOladapo, PPreliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: City Nurses. J Psychiatr Mental Health Nurs 2006; 13: 165–172.CrossRefGoogle ScholarPubMed
Nijman, HLMerckelbach, HLAllertz, WFCampo, JMPrevention of aggressive incidents on a closed psychiatric ward. Psychiatr Serv 1997; 48(5): 694–698.Google ScholarPubMed
Lambert, MJHill, CEAssessing psychotherapy outcomes and processes. In: Bergin, AEGarfield, SL editors. Handbook of psychotherapy and behavioural change. 4th ed., New York: Wiley and Sons; 1994. p. 72–113.Google Scholar
Georgieva, IMulder, CLNoorthoorn, EO Reducing seclusion through involuntary medication: a randomized clinical trial. Psychiatry Res 2012. http://dx.doi.org/10.1016/j.psychres.2012.08.002.CrossRefGoogle Scholar
Veen, RCAde Vruwink, FJVoskes, YMulder, CLNoorthoorn, EOHet Comfortroom-project Mediant. Ervaringen en uitkomsten. Maandblad Geestelijke Gezondheid 2009; 64: 551–560.Google Scholar
Sande van de, RNijman, HLINoorthoorn, EOWierdsma, AIHellendoorn, Evan der Staak, Cet al.Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment. Br J Psychiatry 2011; 199: 473–478.CrossRefGoogle Scholar
Gudjonsson, GHRabe-Hesketh, SSzmulker, GManagement of psychiatric in patient violence: patient ethnicity and the use of medication restraint and seclusion. Br J Psychiatry 2004; 184: 258–262.CrossRefGoogle ScholarPubMed
Abderhalden, CNeedham, IDassen, THalfens, RHaug, HJFisher, JEStructured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry 2008; 193: 44–50.CrossRefGoogle ScholarPubMed
Skrondahl, ARabe-Hesketh, SSome applications of generalized linear latent and mixed models in epidemiology: repeated measures, measurement error and multilevel modeling. Norsk Epidemiologi 2003; 13(2): 265–278.Google Scholar
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