Eric Noorthoorn - Academia.edu (original) (raw)
Papers by Eric Noorthoorn
Advances in Mental Health and Intellectual Disabilities
Purpose A recently published study showed a 41% prevalence of mild intellectual disability (MID) ... more Purpose A recently published study showed a 41% prevalence of mild intellectual disability (MID) and borderline intellectual functioning (BIF) in a large sample of Dutch psychiatric patients. This study aims to examine if the outcomes of the Screener for Intelligence and Learning Disabilities (SCIL) were affected by the severity of psychiatric symptoms during admission. Design/methodology/approach The authors administered the SCIL and the Kennedy Axis V (domain psychological impairment) at two moments when patients were sufficiently stabilised and just before discharge. Findings A total of 86% of the respondents had the same outcome regardless of the time of administration. The Kennedy score correlated modestly with changes in the SCIL scores, suggesting that the severity of psychiatric symptoms just modestly affected the performance. Practical implications Recognising MID/BIF in mental health care is essential but challenging for clinicians. The authors concluded that screening wit...
![Research paper thumbnail of [Could Psychiatry Dispense with Involuntary Medication? - Contra]](https://attachments.academia-assets.com/91463831/thumbnails/1.jpg)
](Psychiatrische Praxis, 2016
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimm... more Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
BJPsych Open
Background It has been suggested that people with intellectual disabilities have a higher likelih... more Background It has been suggested that people with intellectual disabilities have a higher likelihood to develop psychiatric disorders, and that their treatment prognosis is relatively poor. Aims We aimed to establish the prevalence of intellectual disability in different mental healthcare settings, and estimate percentage of cognitive decline. We hypothesised that the prevalence of intellectual disabilities increases with intensity of care. Method A cross-sectional study was conducted in different settings in a mental healthcare trust in the Netherlands. We used the Screener for Intelligence and Learning Disabilities (SCIL) to identify suspected mild intellectual disability (MID) or borderline intellectual functioning (BIF). We identified patients with a high level of education and low SCIL score to estimate which patients may have had cognitive decline. Results We included 1213 consecutive patients. Over all settings, 41.4% of participating patients were positive for MID/BIF and 20...
Tijdschrift voor psychiatrie, May 1, 2021
Achtergrond Het high en intensive care(HIC)-model biedt een kader voor acuteopnameafdelingen en w... more Achtergrond Het high en intensive care(HIC)-model biedt een kader voor acuteopnameafdelingen en wordt sinds 2013 geïmplementeerd door alle ggz-instellingen in Nederland. Doel Nagaan hoe de implementatie van het HIC-model verlopen is tussen 2014 en 2018 en hoe de mate van implementatie van het HIC-model samenhangt met dwangtoepassingen. Methode In 2014-2018 werden in twee fases 79 audits georganiseerd binnen 25 instellingen om de mate van implementatie van HIC in kaart te brengen aan de hand van een modelgetrouwheidsschaal, de HIC-monitor. Scores op de HIC-monitor werden vergeleken met data over dwangtoepassingen om het verband tussen implementatie van het HIC-model en dwangtoepassingen vast te stellen. Resultaten Scores op de HIC-monitor stegen in de loop van de tijd, vooral op het gebied van visie, gastvrijheid en faciliteiten. Een derde van de afdelingen scoorde lager op de HIC-monitor bij de tweede audit ten opzichte van de eerste. Instellingen die hoger scoorden, separeerden minder en gebruikten minder dwangmedicatie onder verzet. Conclusie Er is vooruitgang in implementatie van het HIC-model en instellingen die verder zijn in de implementatie van het HIC-model passen minder dwang toe. Borging van implementatie blijkt lastig. Er dient aandacht uit te gaan naar het landelijke personeelstekort en systematische evaluatie van dwang
Social psychiatry and psychiatric epidemiology, Jan 25, 2015
In the Table 3 of the original publication, the value ''32'' in 5th column has been misplaced. It... more In the Table 3 of the original publication, the value ''32'' in 5th column has been misplaced. It should belong to the third row instead of the fourth row. The correct version of Table 3 is given below: The online version of the original article can be found under
Frontiers in Public Health, 2014
In this review, we compare the use of coercion in mental health care in Germany and in the Nether... more In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million C was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.
Schizophrenia Research, 2003
minimal" and similar to that with placebo. Future research over the longer term with more patient... more minimal" and similar to that with placebo. Future research over the longer term with more patients is needed before recommendations can be made regarding clinical treatment.
Schizophrenia Research, 2003
Schizophrenia Research, 2006
Psychiatry Research, 1995
A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. T... more A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. The study explored (1) the effects of the intervention on the level of expressed emotion (EE) of key relatives; (2) the validity of EE defined by a 5-min speech sample as a predictor of relapse; and (3) the evaluations of the intervention program by patients and key relatives. Four key relatives in the treatment group, compared with none in a waiting list control group, changed from high to low EE levels. The change was clinically but not statistically significant, perhaps because of the small sample size. Patients whose key relatives had low EE levels had a significantly lower number of relapses and hospital admissions compared with those whose key relatives had high EE levels. The psychoeducational program was well received by all participants, and there were no dropouts.
International Journal of Mental Health, 2008
Objective: The use of seclusion in psychiatric practice is a controversial issue in psychiatric p... more Objective: The use of seclusion in psychiatric practice is a controversial issue in psychiatric practice in the Netherlands, as a number of recent studies show seclusion to be a predominant restrictive measure. In contrast to many surrounding countries Dutch legislation is arranged in such a way the protection of the physical integrity of the patient is more important than professional considerations with respect to the treatment of severe mental illness. The opening of a new admission ward provided the opportunity to study the effect of a number of preventive measures both before and after admission on the use of seclusion. Methods: Two admission wards with the approximately the same staff compilation, the same admission criteria and a comparable catchments area were followed for 29 months. In the experimental ward a project was started with the aim to abandon seclusion in three years at the same time reducing all other forms of restrain, the comparable ward had care as usual. Results: The data show a decrease of number and duration of seclusion in the experimental ward in comparison to the ward providing care as usual. This difference could be related to a number of patient and ward characteristics.
International Journal of Law and Psychiatry, 2009
International Journal of Law and Psychiatry, 2008
The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as... more The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as other countries in and outside Europe. The aim of this study is to describe Dutch seclusion data and compare these with data reviewed in the literature. An extensive search revealed only 11 articles containing seclusion rates of regions or whole countries either in Europe, Australia or the United States. Dutch seclusion rates were calculated from a governmental database and from a database covering twelve General Psychiatric Hospitals in the Netherlands. According to the hospitals database, on average one in four hospitalized patients experienced a seclusion episode. The mean duration according to the governmental database is a staggering 16 days. Both numbers seem much higher than comparable numbers in other countries. However, different definitions, inconsistent methods of registration, different methods of data collection and an inconsistent expression of the seclusion use in rates limit comparisons of the rates found in the reviewed studies with the data gathered in the current study. The transparency of reviewed data as well as the data sampled in the twelve Dutch Hospitals is discussed.
International Journal of Law and Psychiatry, 2007
International Journal of Law and Psychiatry, 2011
In many European countries, initiatives have emerged to reduce the use of seclusion and restraint... more In many European countries, initiatives have emerged to reduce the use of seclusion and restraint in psychiatric institutions. To study the effects of these initiatives at a national and international level, consensus on definitions of coercive measures, assessment methods and calculation procedures of these coercive measures are required. The aim of this article is to identify problems in defining and recording coercive measures. The study contributes to the development of consistent comparable measurements definitions and provides recommendations for meaningful data-analyses illustrating the relevance of the proposed framework. Methods: Relevant literature was reviewed to identify various definitions and calculation modalities used to measure coercive measures in psychiatric inpatient care. Figures on the coercive measures and epidemiological ratios were calculated in a standardized way. To illustrate how research in clinical practice on coercive measures can be conducted, data from a large multicenter study on seclusion patterns in the Netherlands were used. Results: Twelve Dutch mental health institutes serving a population of 6.57 million inhabitants provided their comprehensive coercion measure data sets. In total 37 hospitals and 227 wards containing 6812 beds were included in the study. Overall seclusion and restraint data in a sample of 31,594 admissions in 20,934 patients were analyzed. Considerable variation in ward and patient characteristics was identified in this study. The chance to be exposed to seclusion per capita inhabitants of the institute's catchment areas varied between 0.31 and 1.6 per 100.000. Between mental health institutions, the duration in seclusion hours per 1000 inpatient hours varied from less than 1 up to 18 h. The number of seclusion incidents per 1000 admissions varied between 79 up to 745. The mean duration of seclusion incidents of nearly 184 h may be seen as high in an international perspective. Conclusion: Coercive measures can be reliably assessed in a standardized and comparable way under the condition of using clear joint definitions. Methodological consensus between researchers and mental health professionals on these definitions is necessary to allow comparisons of seclusion and restraint rates. The study contributes to the development of international standards on gathering coercion related data and the consistent calculation of relevant outcome parameters.
The British Journal of Psychiatry, 2013
Background The physical environment is presumed to have an effect on aggression and also on the u... more Background The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce. Aims To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care. Method Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses...
The British Journal of Psychiatry, 2011
Background Short-term structured risk assessment is presumed to reduce incidents of aggression an... more Background Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. Aims To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. Method A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. Results The numbers of aggressive incidents (relative risk reduction −68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR =–50%, P<0.05) and the time spent in seclusion (RRR =–45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the ...
The British Journal of Psychiatry, 1992
A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinat... more A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.
BMC Psychiatry, 2012
Background: From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide progr... more 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.
Archives of Psychiatric Nursing, 2012
Determinants of seclusion after aggression in a psychiatric inpatients Some aggressive incidents ... more Determinants of seclusion after aggression in a psychiatric inpatients Some aggressive incidents in psychiatric wards result in seclusion, while others do not. We used the SOAS-R and the mental health trust's database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic, contextual and aggression characteristics, and were analyzed in a multilevel logistic regression. This showed associations between seclusion and aggression for the following: younger age, involuntary status, history of previous aggression, physical or dangerous violence, aggression being directed against objects, and a more severe incident. Thus seclusion after aggression appears to be mainly predicted by aggression itself.
Advances in Mental Health and Intellectual Disabilities
Purpose A recently published study showed a 41% prevalence of mild intellectual disability (MID) ... more Purpose A recently published study showed a 41% prevalence of mild intellectual disability (MID) and borderline intellectual functioning (BIF) in a large sample of Dutch psychiatric patients. This study aims to examine if the outcomes of the Screener for Intelligence and Learning Disabilities (SCIL) were affected by the severity of psychiatric symptoms during admission. Design/methodology/approach The authors administered the SCIL and the Kennedy Axis V (domain psychological impairment) at two moments when patients were sufficiently stabilised and just before discharge. Findings A total of 86% of the respondents had the same outcome regardless of the time of administration. The Kennedy score correlated modestly with changes in the SCIL scores, suggesting that the severity of psychiatric symptoms just modestly affected the performance. Practical implications Recognising MID/BIF in mental health care is essential but challenging for clinicians. The authors concluded that screening wit...
Psychiatrische Praxis, 2016
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimm... more Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
BJPsych Open
Background It has been suggested that people with intellectual disabilities have a higher likelih... more Background It has been suggested that people with intellectual disabilities have a higher likelihood to develop psychiatric disorders, and that their treatment prognosis is relatively poor. Aims We aimed to establish the prevalence of intellectual disability in different mental healthcare settings, and estimate percentage of cognitive decline. We hypothesised that the prevalence of intellectual disabilities increases with intensity of care. Method A cross-sectional study was conducted in different settings in a mental healthcare trust in the Netherlands. We used the Screener for Intelligence and Learning Disabilities (SCIL) to identify suspected mild intellectual disability (MID) or borderline intellectual functioning (BIF). We identified patients with a high level of education and low SCIL score to estimate which patients may have had cognitive decline. Results We included 1213 consecutive patients. Over all settings, 41.4% of participating patients were positive for MID/BIF and 20...
Tijdschrift voor psychiatrie, May 1, 2021
Achtergrond Het high en intensive care(HIC)-model biedt een kader voor acuteopnameafdelingen en w... more Achtergrond Het high en intensive care(HIC)-model biedt een kader voor acuteopnameafdelingen en wordt sinds 2013 geïmplementeerd door alle ggz-instellingen in Nederland. Doel Nagaan hoe de implementatie van het HIC-model verlopen is tussen 2014 en 2018 en hoe de mate van implementatie van het HIC-model samenhangt met dwangtoepassingen. Methode In 2014-2018 werden in twee fases 79 audits georganiseerd binnen 25 instellingen om de mate van implementatie van HIC in kaart te brengen aan de hand van een modelgetrouwheidsschaal, de HIC-monitor. Scores op de HIC-monitor werden vergeleken met data over dwangtoepassingen om het verband tussen implementatie van het HIC-model en dwangtoepassingen vast te stellen. Resultaten Scores op de HIC-monitor stegen in de loop van de tijd, vooral op het gebied van visie, gastvrijheid en faciliteiten. Een derde van de afdelingen scoorde lager op de HIC-monitor bij de tweede audit ten opzichte van de eerste. Instellingen die hoger scoorden, separeerden minder en gebruikten minder dwangmedicatie onder verzet. Conclusie Er is vooruitgang in implementatie van het HIC-model en instellingen die verder zijn in de implementatie van het HIC-model passen minder dwang toe. Borging van implementatie blijkt lastig. Er dient aandacht uit te gaan naar het landelijke personeelstekort en systematische evaluatie van dwang
Social psychiatry and psychiatric epidemiology, Jan 25, 2015
In the Table 3 of the original publication, the value ''32'' in 5th column has been misplaced. It... more In the Table 3 of the original publication, the value ''32'' in 5th column has been misplaced. It should belong to the third row instead of the fourth row. The correct version of Table 3 is given below: The online version of the original article can be found under
Frontiers in Public Health, 2014
In this review, we compare the use of coercion in mental health care in Germany and in the Nether... more In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million C was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.
Schizophrenia Research, 2003
minimal" and similar to that with placebo. Future research over the longer term with more patient... more minimal" and similar to that with placebo. Future research over the longer term with more patients is needed before recommendations can be made regarding clinical treatment.
Schizophrenia Research, 2003
Schizophrenia Research, 2006
Psychiatry Research, 1995
A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. T... more A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. The study explored (1) the effects of the intervention on the level of expressed emotion (EE) of key relatives; (2) the validity of EE defined by a 5-min speech sample as a predictor of relapse; and (3) the evaluations of the intervention program by patients and key relatives. Four key relatives in the treatment group, compared with none in a waiting list control group, changed from high to low EE levels. The change was clinically but not statistically significant, perhaps because of the small sample size. Patients whose key relatives had low EE levels had a significantly lower number of relapses and hospital admissions compared with those whose key relatives had high EE levels. The psychoeducational program was well received by all participants, and there were no dropouts.
International Journal of Mental Health, 2008
Objective: The use of seclusion in psychiatric practice is a controversial issue in psychiatric p... more Objective: The use of seclusion in psychiatric practice is a controversial issue in psychiatric practice in the Netherlands, as a number of recent studies show seclusion to be a predominant restrictive measure. In contrast to many surrounding countries Dutch legislation is arranged in such a way the protection of the physical integrity of the patient is more important than professional considerations with respect to the treatment of severe mental illness. The opening of a new admission ward provided the opportunity to study the effect of a number of preventive measures both before and after admission on the use of seclusion. Methods: Two admission wards with the approximately the same staff compilation, the same admission criteria and a comparable catchments area were followed for 29 months. In the experimental ward a project was started with the aim to abandon seclusion in three years at the same time reducing all other forms of restrain, the comparable ward had care as usual. Results: The data show a decrease of number and duration of seclusion in the experimental ward in comparison to the ward providing care as usual. This difference could be related to a number of patient and ward characteristics.
International Journal of Law and Psychiatry, 2009
International Journal of Law and Psychiatry, 2008
The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as... more The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as other countries in and outside Europe. The aim of this study is to describe Dutch seclusion data and compare these with data reviewed in the literature. An extensive search revealed only 11 articles containing seclusion rates of regions or whole countries either in Europe, Australia or the United States. Dutch seclusion rates were calculated from a governmental database and from a database covering twelve General Psychiatric Hospitals in the Netherlands. According to the hospitals database, on average one in four hospitalized patients experienced a seclusion episode. The mean duration according to the governmental database is a staggering 16 days. Both numbers seem much higher than comparable numbers in other countries. However, different definitions, inconsistent methods of registration, different methods of data collection and an inconsistent expression of the seclusion use in rates limit comparisons of the rates found in the reviewed studies with the data gathered in the current study. The transparency of reviewed data as well as the data sampled in the twelve Dutch Hospitals is discussed.
International Journal of Law and Psychiatry, 2007
International Journal of Law and Psychiatry, 2011
In many European countries, initiatives have emerged to reduce the use of seclusion and restraint... more In many European countries, initiatives have emerged to reduce the use of seclusion and restraint in psychiatric institutions. To study the effects of these initiatives at a national and international level, consensus on definitions of coercive measures, assessment methods and calculation procedures of these coercive measures are required. The aim of this article is to identify problems in defining and recording coercive measures. The study contributes to the development of consistent comparable measurements definitions and provides recommendations for meaningful data-analyses illustrating the relevance of the proposed framework. Methods: Relevant literature was reviewed to identify various definitions and calculation modalities used to measure coercive measures in psychiatric inpatient care. Figures on the coercive measures and epidemiological ratios were calculated in a standardized way. To illustrate how research in clinical practice on coercive measures can be conducted, data from a large multicenter study on seclusion patterns in the Netherlands were used. Results: Twelve Dutch mental health institutes serving a population of 6.57 million inhabitants provided their comprehensive coercion measure data sets. In total 37 hospitals and 227 wards containing 6812 beds were included in the study. Overall seclusion and restraint data in a sample of 31,594 admissions in 20,934 patients were analyzed. Considerable variation in ward and patient characteristics was identified in this study. The chance to be exposed to seclusion per capita inhabitants of the institute's catchment areas varied between 0.31 and 1.6 per 100.000. Between mental health institutions, the duration in seclusion hours per 1000 inpatient hours varied from less than 1 up to 18 h. The number of seclusion incidents per 1000 admissions varied between 79 up to 745. The mean duration of seclusion incidents of nearly 184 h may be seen as high in an international perspective. Conclusion: Coercive measures can be reliably assessed in a standardized and comparable way under the condition of using clear joint definitions. Methodological consensus between researchers and mental health professionals on these definitions is necessary to allow comparisons of seclusion and restraint rates. The study contributes to the development of international standards on gathering coercion related data and the consistent calculation of relevant outcome parameters.
The British Journal of Psychiatry, 2013
Background The physical environment is presumed to have an effect on aggression and also on the u... more Background The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce. Aims To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care. Method Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses...
The British Journal of Psychiatry, 2011
Background Short-term structured risk assessment is presumed to reduce incidents of aggression an... more Background Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. Aims To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. Method A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. Results The numbers of aggressive incidents (relative risk reduction −68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR =–50%, P<0.05) and the time spent in seclusion (RRR =–45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the ...
The British Journal of Psychiatry, 1992
A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinat... more A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.
BMC Psychiatry, 2012
Background: From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide progr... more 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.
Archives of Psychiatric Nursing, 2012
Determinants of seclusion after aggression in a psychiatric inpatients Some aggressive incidents ... more Determinants of seclusion after aggression in a psychiatric inpatients Some aggressive incidents in psychiatric wards result in seclusion, while others do not. We used the SOAS-R and the mental health trust's database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic, contextual and aggression characteristics, and were analyzed in a multilevel logistic regression. This showed associations between seclusion and aggression for the following: younger age, involuntary status, history of previous aggression, physical or dangerous violence, aggression being directed against objects, and a more severe incident. Thus seclusion after aggression appears to be mainly predicted by aggression itself.