Gemsa Stephan, Noorthoorn Eric O, Lepping Peter, de Haan Hein A, Wierdsma Andre I, Hutschemaekers Giel J M
Ggnet Mental Health Institute, Child Psychiatry Service, Warnsveld, Netherlands.
Betsi Cadwaladr University Health Board, Wrexham, United Kingdom.
Front Psychiatry. 2022 Feb 8;12:770934. doi: 10.3389/fpsyt.2021.770934. eCollection 2021.
On January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) replaced the Special Admissions Act (BOPZ). While the old law only allowed compulsory treatment in hospitals, the new law allows it both inside and outside the hospital. Moreover, the new law prioritizes the patient's own opinion on coercive measures. By following patients' own choices, the Compulsory Care Act is hoped to lead to fewer admission days and less inpatient compulsory treatment in involuntarily admitted patients.
We studied the seclusion and enforced-medication events before and after January 1, 2020, using coercive measures monitoring data in a Mental Health Trust. Trends in hours of seclusion and the number of enforced-medication events per month from 2012 to 2019 were compared with 2020. We used generalized linear models to perform time series analysis. Logistic regression analyses and generalized linear models were performed to investigate whether patient compilation determined some of the observed changes in seclusion use or enforced-medication events.
The mean number of hours of seclusion between 2012 and 2019 was 27,124 per year, decreasing from 48,542 in 2012 to 21,133 in 2019 to 3,844 h in 2020. The mean incidence of enforced-medication events between 2012 and 2019 was 167, increasing from 90 in 2012 to 361 in 2019 and then fell to 294 in 2020. In 2020, we observed 3,844 h of seclusion and 294 enforced-medication events. Near to no outpatient coercion was reported, even though it was warranted. The time series analysis showed a significant effect of the year 2020 on seclusion hours (β = -1.867; Exp(β) = 0.155, Wald = 27.22, p = 0.001), but not on enforced-medication events [β = 0.48; Exp(β) = 1.616, Wald = 2.33, = 0.13].
There was a reduction in the number of seclusion hours after the introduction of the Compulsory Care Act. The number of enforced-medication events also increased from a very low baseline, but from 2017 onwards. To see whether these findings are consistent over time, they need to be replicated in the near future.
We observed a significant increase in enforced-medication use and a decrease in seclusion hours. The year 2020 predicted seclusion hours, but not enforced-medication events.
2020年1月1日，荷兰《强制护理法》（WvGGZ）取代了《特殊收治法》（BOPZ）。旧法仅允许在医院进行强制治疗，而新法允许在医院内外进行强制治疗。此外，新法优先考虑患者对强制措施的个人意见。通过遵循患者自己的选择，希望《强制护理法》能减少非自愿收治患者的住院天数和住院强制治疗次数。
我们利用一家心理健康信托机构的强制措施监测数据，研究了2020年1月1日前后的隔离和强制用药事件。将2012年至2019年每月的隔离时长趋势和强制用药事件数量与2020年进行比较。我们使用广义线性模型进行时间序列分析。进行逻辑回归分析和广义线性模型分析，以调查患者配合情况是否决定了观察到的隔离使用或强制用药事件的某些变化。
2012年至2019年期间，每年的平均隔离时长为27124小时，从2012年的48542小时降至2019年的21133小时，再到2020年的3844小时。2012年至2019年期间，强制用药事件的平均发生率为167起，从2012年的90起增至2019年的361起，然后在2020年降至294起。2020年，我们观察到3844小时的隔离和294起强制用药事件。几乎没有报告门诊强制情况，尽管有必要进行门诊强制。时间序列分析显示，2020年对隔离时长有显著影响（β = -1.867；Exp(β) = 0.155，Wald = 27.22，p = 0.001），但对强制用药事件没有显著影响[β = 0.48；Exp(β) = 1.616，Wald = 2.33，p = 0.13]。
《强制护理法》实施后，隔离时长有所减少。强制用药事件数量也从非常低的基线开始增加，但从2017年起开始增加。为了确定这些发现是否随时间一致，需要在不久的将来进行重复验证。
我们观察到强制用药的使用显著增加，隔离时长减少。2020年可预测隔离时长，但不能预测强制用药事件。
