Long-Term Impact of a Tailored Seclusion Reduction Program: Evidence for Change?
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International comparative studies show that Dutch seclusion rates are relatively high. Therefore, several programs to change this practice were developed and implemented. The purpose of this study was to examine the impact of a seclusion reduction program over a long time frame, from 2004 until 2013. Three phases could be identified; the phase of development and implementation of the program (2004–2007), the project phase (2008–2010) and the consolidation phase (2011–2013). Five inpatient wards of a mental health institute were monitored. Each ward had one or more seclusion rooms. Primary outcome were the number and the duration of seclusion incidents. Involuntary medication was monitored as well to rule out substitution of one coercive measure by another. Case mix correction for patient characteristics was done by a multi-level logistic regression analysis with patient characteristics as predictors and hours seclusion per admission hours as outcome. Seclusion use reduced significantly during the project phase, both in number (−73%) and duration (−80%) and was not substituted by the use of enforced medication. Patient compilation as analyzed by the multi- level regression seemed not to confound the findings. Findings show a slight increase in number and seclusion days over the last year of monitoring. Whether this should be interpreted as a continuous or temporary trend remains unclear and is subject for further investigation.
KeywordsInpatient psychiatry Seclusion Organizational change Program evaluation
Compliance with Ethical Standards
Conflict of Interest
Eric O Noorthoorn works one day a week in a government funded national case register on coercive measures. All other authors declare they have no conflict of interest.
The study was performed as part of a PhD, with no specific funding. With respect to ethical approval, the article does not contain any direct participation of subjects interviewed by any of the authors. Data were gathered for health care policy monitoring purposes and were based on health care information, which in the current Dutch law does not require procedures involving informed consent. The procedure followed in the study was formally agreed upon by the ethical committee of the General Hospital of Enschede in 2006 and is in line with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This research reported in the current study received no specific grant from any funding agency, commercial or not-for-profit sectors.
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