Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
GGZ Oost Brabant, Boekel, The Netherlands.
Psychiatr Q. 2020 Sep;91(3):819-834. doi: 10.1007/s11126-020-09738-1.
From 2004 onwards, above 50 seclusion reduction programs (SRP) were developed, implemented and evaluated in the Netherlands. However, little is known about their sustainability, as to which extent obtained reduction could be maintained. This study monitored three programs over ten years seeking to identify important factors contributing to this. We reviewed documents of three SRPs that received governmental funding to reduce seclusion. Next, we interviewed key figures from each institute, to investigate the SRP documents and their implementation in practice. We monitored the number of seclusion events and the number of seclusion days with the Argus rating scale over ten years in three separate phases: 2008-2010, 2011-2014 and 2015-2017. As we were interested in sustainability after the governmental funding ended in 2012, our focus was on the last phase. Although in different rate, all mental health institutes showed some decline in seclusion events during and immediately after the SRP. After end of funding one institute showed numbers going up and down. The second showed an increase in number of seclusion days. The third institute displayed a sustained and continuous reduction in use of seclusion, even several years after the received funding. This institute was the only one with an ongoing institutional SRP after the governmental funding. To sustain accomplished seclusion reduction, a continuous effort is needed for institutional awareness of the use of seclusion, even after successful implementation of SRPs. If not, successful SRPs implemented in psychiatry will easily relapse in traditional use of seclusion.
自 2004 年以来，荷兰开发、实施和评估了 50 多个以上的隔离减少项目（SRP）。然而，对于它们的可持续性，即已经实现的减少量能够维持多久，人们知之甚少。本研究监测了三个项目超过十年，以确定促成这一点的重要因素。我们审查了三个获得政府资金以减少隔离的 SRP 项目的文件。接下来，我们采访了每个机构的关键人物，以调查 SRP 文件及其在实践中的实施情况。我们使用 Argus 评分量表监测了三个独立阶段的十年内的隔离事件数量和隔离天数：2008-2010 年、2011-2014 年和 2015-2017 年。由于我们对 2012 年政府资金结束后的可持续性感兴趣，因此我们的重点是最后一个阶段。尽管下降的速度不同，但所有精神卫生机构在 SRP 期间和之后都显示出隔离事件有所减少。在资金结束后，一个机构的数字上下波动。第二个机构显示出隔离天数的增加。第三个机构显示出隔离使用的持续和连续减少，即使在获得资金后的几年也是如此。该机构是唯一在政府资金结束后仍在进行机构性 SRP 的机构。为了维持已实现的隔离减少，即使在成功实施 SRP 之后，也需要机构对隔离使用的持续关注。否则，精神病学中成功实施的 SRP 很容易恢复为传统的隔离使用。
