Page 66 - Reduction of coercive measures

Chapter 3
Expert opinion
Opinions about definition of involuntary care
The experts believed that the definition of involuntary care used in the Care and Coercion Act – all forms of care resisted by the client or his representative – is inadequate. The inclusion of resistance in the definition of involuntary care (or, indeed, limiting the definition to situations involving resistance) provoked critical comments. Indeed, as the legislator states, resistance is by no means always easy for care providers to recognise (Parliamentary Papers II, 2015/16, 32299, No. 25). The experts endorsed this and expressed their concern that this definition has been worded “too narrowly” and would not help, therefore, to ensure reliable and uniform reporting of involuntary care. Adding the word “resistance” to the definition of involuntary care would result in a lack of clarity, given that care providers do not always notice resistance, while it is also possible that clients might not resist. Resistance can also weaken, or disappear, if it fails to produce the result the client wants within a certain period. As the research by De Boer et al. (2018) and Dörenberg et al. (2018) shows, there is a discrepancy between how care providers assess situations and the way in which clients’ resistance to involuntary care is actually experienced or recognised. If care providers lack the expertise needed to recognise resistance, involuntary care will be externally under-reported. Paying more attention to recognising signs of resistance would, therefore, seem vital if the legislator wishes to maintain this limited definition of involuntary care. Another potential conflict can arise if a client and his legal representative are not in agreement. In the experts’ view, the description of the nine forms of involuntary care is insufficiently concrete and so will not end the discussion of what involuntary care does and does not constitute. This, however, is precisely what the legislator is seeking to achieve by introducing the new definition and subdividing such care into categories (Steen et al., 2016). According to the experts, the categories set in the legislation do not provide a sufficiently clear basis for achieving a uniform external reporting system, and more concrete specification is, in the opinion of the experts, needed to achieve change in practice. The problems include
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