Policies limit the use of coercive measures as a measure of last resort to protect people from danger. Success of policies can only be determined by registering the use of coercive measures. The reliability of 57 standardized coercive measures was tested. In addition, implementation was investigated of improved registration in a residential care setting. This mixed methods study within a residential care organization for people with intellectual disabilities in the Netherlands included 55 living units and 269 residents. Reliability of 57 standardized coercive measures was tested against other informants (colleague staff, trained outside observer) and results were validated by a panel of stakeholders. Second, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to personal files of 30 residents. Registration of coercive measures yielded reliable data for at least 25 out of 57 types of coercive measures. The second part of the study showed widely varying explanations of unreliable data by stakeholders, including knowledge and awareness of coercive measures of support staff and the influence of contextual factors on the encoding of coercive measures. After implementation, 46% of the coercive measures were registered in the registration system. Comprehensive registration of coercive measures by staff neither appeared feasible nor yielded reliable data. Clearly, multidisciplinary discussion among support staff and professionals is needed to decide whether care practices are restrictive or not. Further research should focus on how these considerations can lead to a reliable and meaningful registration.

Purpose The purpose of this paper is to advance a number of outlooks on the reporting of the use of coercive measures in the care for persons with intellectual disabilities. The following questions will be discussed: which forms of involuntary care should be externally reported and how is this external reporting influenced by environmental and other factors? Design/methodology/approach This paper describes an important part of the New Dutch Care and Coercion Act (Wet zorg en dwang) concerning reporting the use of coercive measures. The implications of reporting the use of coercive measures have been discussed at a meeting for experts in mental health law and the care of people with an intellectual disability. The issue has been presented to the participants as neutrally as possible, so as to provide the researchers a comprehensive picture of the different views on reporting the use of coercive measures. The outcome of this meeting has served as the input for a further step in the research – using the Delphi method – in order to address the issue comprehensively. Findings The Dutch legislation on reporting involuntary care implies that measures carried out only in the face of resistance should be externally reported. The experts that participated in this study endorse the importance of a real-time external reporting system. They believe that standardized and reliable external reporting requires involuntary care, the categories of involuntary care and the environmental and other factors that affect external reporting to be defined more concretely. They regard environmental and other factors as decisive for assessing whether a measure constitutes involuntary care. This in turn, therefore, has consequences for whether such incidents should be reported. Research limitations/implications Many concepts in the new Dutch Care and Coercion Act (Wet zorg en dwang) are not formally defined. Instead, the legislator has left it to those in the field to decide how they should be interpreted. This prompted many questions from those attending the expert meeting and in our own analysis. The researchers could possibly have resolved this confusion during the meeting by formulating more detailed definitions of terms such as “resistance” and “involuntary care” beforehand. The disadvantage of this, however, would have been that those attending the meeting would have had no opportunity to define the terms on the basis of their own expertise. As a result, the researchers have obtained all relevant information comprehensively to use as the input for the next step of the research, which employs the Delphi method. Practical implications This viewpoint emphasises the need to take a wide range of factors into account throughout the process in order to establish whether care can be seen as involuntary. The researchers regard the care providers’ expertise in dealing with these factors – client factors, and behavioural or environmental factors, for example – as being of essential importance if care is to be recognised as involuntary and reported as effectively as possible. Therefore, the researchers discuss whether the legal position of clients is protected if care providers register only those forms of involuntary care where there is obvious resistance. In this case, many forms of resistance are overlooked, which may be to the detriment of the legal protection of clients with intellectual disabilities. However, the system in the UK shows that it can be quite complicated to develop a clear definition of involuntary care that is usable in practice, without giving rise to an enormous amount of bureaucracy and thus distracting from the real issue: protecting the legal position of clients with an intellectual disability. Originality/value Academic papers clearly demonstrate that external reporting of involuntary care has not yet become properly established, either in the Netherlands or elsewhere, such as in the UK. This paper seeks to provide insights into new Dutch legislation about external reporting of involuntary care. By organising a meeting with experts, the factors that have so far acted as obstacles in the reporting of involuntary care are problematized. The findings of this paper will help to further the process of developing an effective system for reporting involuntary care.

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