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Legal regulation and policy on the use of restraint and coercive measures in health care institutions in the Netherlands
Published in Bernadette McSherry, Yvette Maker, Restrictive Practices in Health Care and Disability Settings, 2020
This chapter refers to different forms of treatment and interventions. The term ‘involuntary treatment’ is used to refer to any kind of treatment or intervention, such as placing an individual in a seclusion room, which takes places without the individual’s consent. Consent can be withheld in a number of ways, including by refusing to sign a consent form, but also by displaying physical resistance or refusing to agree to an intervention verbally or non-verbally. Under Dutch law, involuntary treatment is treatment which takes place without the consent of the individual and involves treatment which is not foreseen in the individual’s care plan. Such treatment may only take place in institutions which have been registered with the Ministry of Health, Welfare and Sport (discussed further later).
Addiction and Mandatory Treatment
Published in Hanna Pickard, Serge H. Ahmed, The Routledge Handbook of Philosophy and Science of Addiction, 2019
Coercion, then, works through the will of the coerced, and it occurs typically within the criminal justice system. This is contrasted with compulsory treatment where the affected persons are simply directed into treatment without regard for their preferences. (Sometimes ‘involuntary treatment’ or ‘forced treatment’ are used as synonyms for ‘compulsory treatment’.) Compulsory treatment orders can be applied to offenders within criminal justice – this is known as court-mandated treatment – or in the health sector, where they can be applied in civil proceedings where no offence has been committed – this is known in most jurisdictions as civil commitment.
Historical perspectives in medical ethics
Published in Andreas Müller, Peter Schaber, The Routledge Handbook of the Ethics of Consent, 2018
Detention and involuntary treatment for mental health conditions in common law jurisdictions is often governed by criteria other than someone’s capacity to make competent decisions. The formalization of grounds for compulsory admission begun in the late nineteenth century has focused upon risk to self or others. For instance, English law in the twentieth century settled on the necessary and sufficient grounds that the patient has a mental disorder of a nature or degree that means treatment in hospital is both appropriate and necessary for the health or safety of the patient, or for the protection of other people (The Mental Health Act 1983: §3.2). The ethical justifications for these criteria are a mixture of paternalism and respect for the liberty of others. While detention and involuntary treatment on the grounds of the health or safety of the patient might seem to depart from Mill’s defense of self-sovereignty, his qualification that “this doctrine is meant to apply only to human beings in the maturity of their faculties” rather than “those still in a state to require being taken care of by others” (1999: I.10) can appear to render them consistent. Whatever the implication of Mill’s own position, there remains concern about the extent of paternalistic intervention in both formal and informal mental health care, as well as restricting liberty on the grounds of assessments of risk to others rather than harms actually committed.
Clinical validation of the Symptom Self-rating Scale for Schizophrenia (4S) among inpatients
Published in Nordic Journal of Psychiatry, 2021
Pernille Kølbæk, Daniel Guinart, Mark Opler, Christoph U. Correll, Ole Mors, Søren D. Østergaard
Study participants were recruited by staff members from inpatient units at the Department for Psychosis at Aarhus University Hospital – Psychiatry, Denmark, from 01/2018 to 10/2019. Inclusion criteria were: (i) meeting the criteria for schizophrenia (F20.x.) according to the International Classification of Disease, 10th revision (ICD-10) confirmed by the treating psychiatrist, (ii) age ≥18 years, and (iii) understanding spoken and written Danish. Exclusion criteria were: (i) comorbid organic mental disorder (ICD-10: F0x.x), (ii) comorbid mental retardation (IQ < 70), (iii) being under the influence of psychoactive substances and/or alcohol (as per clinical assessment by the referring clinician), and/or (iv) involuntary treatment (e.g. involuntary admission, involuntary medication, or physical restraint). A total of 77 participants were rated by clinicians using the PANSS-6. Of these, 61 (79%) individuals completed the 4S at least once and thus comprise the study sample. All participants provided written informed consent. Ethics review committee approval and study overview are not required for non-interventional studies as per Danish law and regulations. Data were processed and stored in accordance with the European Union General Data Protection Regulation.
Patient satisfaction and acute psychiatric inpatient treatment
Published in Nordic Journal of Psychiatry, 2020
Ann Færden, Brita Bølgen, Lars Løvhaug, Christian Thoresen, Ingrid Dieset
Voluntary (VA) and involuntary admission (IA) in the Norwegian health care system is regulated by the Mental Health Care Act from 2001 and amendments from 2007 [45]. A specialist in psychiatry must evaluate the patient who has been involuntarily referred to within 24 hours. Involuntary admission may be in terms of involuntary observation or involuntary treatment. In the cases of observation a new evaluation must be made within 10 days and changed either to VA or IA. IA can be appealed by the patient to the local Judical Committee. The patient is assigned a lawyer free of charge for representation in the appeal. Coercive measures such as seclusion, isolation, use of restraints and pharmacological treatment againts the patient`s consent are regulated by different sections of the Mental Health Act and can also be appealed.
Involuntary Hospitalization of Suicidal Patients: Time for New Answers to Basic Questions?
Published in The American Journal of Bioethics, 2019
What seems striking in the discussion about coercion is the ambiguous position of psychiatrists, that is, the profession that is entitled and expected to exert coercion. While there are no randomized controlled trials on the effectiveness of involuntary treatment in hospitals, rigorous trials have been conducted on whether involuntary treatment in the community is effective. On a group level, involuntary community treatment has no benefit for patients whatsoever (Kisely and Hall 2014). Yet by and large, psychiatrists and their professional associations have not used this evidence to argue for abolishing involuntary treatment in the community, but rather dismissed it. On the other hand, psychiatrists do not appear to be just keen on using coercion either. A qualitative study showed that clinicians in different world regions tend to use persuasion, personal leverage, and threats to make patients accept treatment. Such interventions are sometimes referred to as “informal coercion” and are commonly used to avoid using formal coercion. Although clinicians widely use these interventions, they are often uncomfortable about it and would prefer not to feel driven to using them (Valenti et al. 2015). All this may need a public and more extensive debate among psychiatrists and the wider public about whether psychiatrists should use coercion—and what the alternatives are. Currently, there are glimpses of such a debate but overall it seems rather avoided by professional associations than actively sought.