Page 13 - Reduction of coercive measures

Depending on their needs, people with intellectual disabilities use long-term care within their own homes, at day care centers, or within residential 24-hour care centers. There are an estimated 135,000 people with intellectual disabilities in the Netherlands, 76,000 of whom use residential care (Schipper, 2014). In the context of residential care, people with intellectual disabilities are often subjected to coercive measures (Fitton & Jones, 2018; Romijn & Frederiks, 2012). In its broadest definition, coercive measures refer to any specific form of care by which the individual person is restricted (Romijn & Frederiks, 2012). Coercive measures as defined in this way include a variety of care practices such as confining persons to their room, tying persons down, locking doors and cupboards, sedating persons, and excluding people from group activities and restriction of access to phones and computers (Dörenberg et al., 2018). The adoption of a broad definition of coercive measures marks a shift in public and professional focus from specific, concrete practices, such as physical fixation or seclusion by means of confinement, towards the abstract notion of subjecting people to coercion in the context of care. This progression is taking place in parallel with the development of the normalization paradigm. The principle of normalization has been gaining influence on practice since 1969 (Van Gennep, 1997), calling for society as a whole to approach people with intellectual disabilities as full citizens with full rights. Everyday life of people with intellectual disabilities should take place as close as possible to the mainstream of society (Van der Meulen, Hermsen, & Embregts, 2018; Van Gennep, 1997). Normalization should not only apply to the topographical and social sphere where everyday life takes place, but also to the sphere of exercising rights and enjoying freedom. Self-determination has also been included in common conceptions of quality of life of people with disabilities (Schalock et al., 2002). As a result of the wide acceptance of the normalization principle, it is upon everyone involved in providing care for people with intellectual disabilities to work towards the reduction and minimization of the use of coercive measures (Frederiks, 2007; Van der Meulen et al., 2018).
General introduction
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