Page 58 - Reduction of coercive measures

Chapter 3
Defining involuntary care
The currently applicable Psychiatric Hospitals (Compulsory Admissions) Act does not define freedom-restricting measures, but instead distinguishes various ways in which freedom can be restricted. This includes coercive treatment measures, such as the forced administration of fluid, food or medication; or seclusion, separation and restraint for periods of up to seven days depending on whether the measure is written down in the care or support plan.
The lack of a definition in the current legislation is one of the reasons why care providers, the government and the academic world in the Netherlands define restrictions on freedom in very different ways (Schippers &Janssen, 2016; Schippers, Frederiks, Van Nieuwenhuijzen, & Schuengel, 2018: Chapter 2 of this dissertation). This, in turn, has considerable consequences in practice, including both under-reporting and over-reporting of involuntary care. For years, many restrictions on freedom have not been recognised as such and have not, therefore, been reported. This was one of the main conclusions reached in 2002 at the time of the second evaluation of the Psychiatric Hospitals (Compulsory Admissions) Act (Arends, Blankman, & Frederiks, 2002).
Similarly, the issues of defining coercive measures are found in other countries (Romijn &Frederiks, 2012). In the UK, many questions have arisen about the interpretation of deprivation of liberty. The Deprivation of Liberty Safeguards (DOLS) were introduced in April 2009 to amend the Mental Capacity Act 2005. DOLS govern the process by which people who lack capacity to consent to accommodation in a care home of hospital can be deprived of liberty (Bartlett, 2014). Capacity is an element which is of less importance in the Care and Coercion Act, in which serious disadvantage is the main criterion for deciding whether coercive measures are allowed. The Mental Capacity Act allows certain restrictions and restraints, but when the measures cross the line and lead to the deprivation of a person’s liberty, an “external” authorisation is required (Department of Health, 2008). The DOLS Code of Practice seems to leave a lot of room for interpretation, for example, page 10: “a decision as to whether or not deprivation of liberty arises will depend on all the circumstances of
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