Page 68 - Reduction of coercive measures

Chapter 3
Relevant factors reporting involuntary care
Resistance is not the only crucial concept influencing the reporting of involuntary care. According to the experts, there are far more factors that affect how care providers interpret involuntary care. Differing interpretations of involuntary care can result in these forms of care being under-reported or not being reported at all. The factors mentioned by the experts can be divided into three subcategories: organizational, contextual, and client-related. Organizational factors include staff shortages, poorly educated staff, and working on the basis of fixed routines. From an organizational perspective, it is of particular importance that external reporting is not made too burdensome, that the purpose of the reporting is clear, and that external reporting is not used as a means of or tool for reprimanding staff. It may also be important for an external reporting system to include certain client characteristics – such as age, developmental level, the existence of a psychopathology, details of physical illnesses/medical conditions, and whether a client has been admitted voluntarily or involuntarily. The experts also believe that all forms of involuntary care provided to children should be reported, regardless of whether the client resists. In addition, they believe that more details need to be recorded of clients who are legally incapacitated than of clients who are not legally incapacitated. Mention was also made of the term “pedagogical measures” with regard to the provision of care in a developmental context, with specific attention being paid to the acquisition of certain skills, where, for example, boundaries may need to be set. The experts’ views on whether such care should be regarded as involuntary varied. Certain environmental factors also play a role: living in group accommodation, for example, involves certain rules that clients may regard as restricting their freedom. So, too, may measures that are applied in response to behavior by fellow residents, or the sharing of accommodation without having any say about the other people living there. In the experts’ view, the external reporting system should also take account of the risks for the client or his surroundings, or both, when a measure is not applied.
Finally, the experts believe that how measure is applied has consequences for the reporting, as does the duration of the measure.
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