Verlinde A A, Snelleman W, van den Berg H, Noorthoorn E O
Tijdschr Psychiatr. 2014;56(10):640-8.
Since the Dutch Mental Health Act of 1984 came into effect, seclusion has often been used as the measure of choice for dealing with aggressive or dangerous patients. In 2012 the Ministry of Health formulated a policy whereby seclusion was to be phased out, but not replaced by involuntary medication. In 2007, within the framework of the Mental Health Act, the Argus system of registering coercive measures was introduced in order to monitor the reduction in the use of seclusion and involuntary medication. This article describes, in a longitudinal cohort study, the effect of the policy to reduce aggression by replacing seclusion through the use of involuntary medication or other measures.
To investigate whether, in the long run, a reduction in the use of seclusion will lead to a proportional increase in the use of involuntary medication, and to assess whether this policy can really be termed 'substitution.
We performed this study by analysing Argus data for the period 2007-2011, relating to 1843 patients being treated by Mediant. ESULTS The changing proportions of seclusion and involuntary medication over time demonstrated that the use of involuntary medication did result in patients being secluded for a shorter period of time.
In the case of dangerous psychiatric patients, medication, administered forcibly when necessary, is preferable to seclusion as far as subsidiarity, proportionality and expediency are concerned. A strategy whereby medication provides appropriate treatment and seclusion is kept within reasonable limits cannot be termed 'substitution'.
自1984年荷兰《精神卫生法》生效以来，隔离常常被用作应对具有攻击性或危险性患者的首选措施。2012年，卫生部制定了一项政策，即逐步淘汰隔离措施，但不采用非自愿用药取而代之。2007年，在《精神卫生法》框架内引入了阿格斯强制治疗措施登记系统，以监测隔离和非自愿用药使用量的减少情况。本文在一项纵向队列研究中描述了通过使用非自愿用药或其他措施替代隔离来减少攻击行为的政策效果。
调查从长远来看，减少隔离措施的使用是否会导致非自愿用药的使用成比例增加，并评估这项政策是否真的可以被称为“替代”。
我们通过分析2007年至2011年期间与Mediant治疗的1843名患者相关的阿格斯数据来开展这项研究。结果随着时间推移，隔离和非自愿用药比例的变化表明，非自愿用药确实使患者的隔离时间缩短。
就辅助性、相称性和权宜性而言，对于危险的精神病患者，必要时强制用药比隔离更为可取。药物治疗提供适当治疗且隔离保持在合理限度内的策略不能被称为“替代”。
