title: Seclusion Reduction in Dutch Mental Health Care: Did Hospitals Meet Goals?
abstract: In 2006, a goal of reducing seclusion in Dutch hospitals by at least 10% each year was set. More than 100 reduction projects in 55 hospitals have been conducted, with €35 million in funding. This study evaluated the results.
  
  
  
  Data (2008 to 2013) were from a national register. Multilevel logistic regression examined determinants of seclusion.
  
  
  
  Hospital participation in the register ranged from eight in 2008 to 66 in 2013, and admissions ranged from 11,300 to 113,290. The average yearly nationwide reduction of secluded patients was about 9%. Reduction was achieved in half of the hospitals. Some hospitals saw increased rates. In some hospitals where seclusion decreased, use of forced medication increased. Higher seclusion rates were associated with psychotic and bipolar disorders, male gender, and several ward types.
  
  
  
  Seclusion decreased significantly, and forced medication increased. Rates varied widely between hospitals. For many hospitals, more efforts to reduce seclusion are needed.
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Noorthoorn
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Voskes
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Janssen
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Roland
authors.initials: R
authors.lastname: van de Sande
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Henk L I
authors.initials: HL
authors.lastname: Nijman
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Annet
authors.initials: A
authors.lastname: Smit
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Hoogendoorn
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Annelea
authors.initials: A
authors.lastname: Bousardt
authors.affiliation: Dr. Noorthoorn and Ms. Bousardt are with Forensische Psychiatrie de Boog, GGnet Geestelijke Gezondheidszorg, Zutphen, the Netherlands. Dr. Noorthoorn is also with the Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, the Netherlands (e-mail: e.noorthoorn@ggnet.nl ). Dr. Voskes and Prof. Widdershoven are with the Department of Medical Humanities and with the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam. Dr. Janssen is with the Faculty of Health, Nutrition and Sports, The Hague University of Applied Science, the Hague. Prof. Mulder is with Parnassia Psychiatric Institute and Erasmus MC Rotterdam, the Netherlands. Dr. van de Sande is with the Institute of Nursing Studies, Utrecht University of Applied Science, and with the Centre of Excellence in Acute Care, Parnassia Psychiatric Institute, Utrecht, the Netherlands. Prof. Nijman is with Aventurijn-Fivoor, Den Dolder, the Netherlands, and with Radboud University, Nijmegen, the Netherlands. Dr. Smit is with Pro Persona Research, Wolfheze, the Netherlands. Dr. Hoogendoorn is with the Department of Psychiatry and EMGO+ Institute, GGZ inGeest, VU University Medical Center, Amsterdam.
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Widdershoven
mesh_terms: D000328:Adult; D003068:Coercion; D005260:Female; D006040:Goals; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data*; D010356:Patient Isolation / Q000706:statistics & numerical data* / Q000639:trends