title: The effects of a nationwide program to reduce seclusion in the Netherlands.
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.
authors.affiliation: GGNet, PO Box 2003, 7230 GC, Warnsveld, the Netherlands. fleurvruwink@gmail.com
authors.forename: Fleur J
authors.initials: FJ
authors.lastname: Vruwink
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
authors.forename: Eric O
authors.initials: EO
authors.lastname: Noorthoorn
authors.forename: Daan
authors.initials: D
authors.lastname: Uitenbroek
authors.forename: Henk L I
authors.initials: HL
authors.lastname: Nijman
mesh_terms: D003068:Coercion; D003695:Delivery of Health Care / Q000592:standards; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000592:standards; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D010356:Patient Isolation