Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands

Abstract

Background A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion. Methods In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics. Results Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. Conclusions This study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.

The Compulsory Care Act: Early Observations and Expectations of In- or Outpatient Involuntary Treatment

“…This was an interpretation not based on patients' opinions (11). As an effect of the absence of effective treatment, seclusion duration was much higher than in other European countries (10,16).…”

“…Nurses are engaged in containing behavior rather than in coming into contact (26). The high and intensive care policy that was developed in 2012 aimed to reduce coercive measures as much as possible in keeping with these findings (16,21).…”

“…In 2014, all Trusts participated. Data gathered in the nationwide databases ( 10 , 12 , 16 ) and through open sources ( 18 ) showed that the seclusion-reduction programs led to a sharp decrease in seclusion use in some but not all hospitals. Overall, the decrease was more evident in the first 5 years of the reduction programs but then plateaued ( 18 , 19 ).…”

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“…Both approaches have been formulated as care models, based on a comprehensive set of best- and evidence-based practices to support care professionals and institutions to intensify care in case of a crisis, and prevent and reduce the use of coercive measures. Currently, the care models are being implemented nationwide in Dutch (forensic) mental healthcare institutions [ 2 , 3 ].…”