Separeren: medisch en politiek probleem

Seclusion, i.e. locking up psychiatric patients in safety rooms as a coercive measure, is common practice in the Netherlands. The Dutch mental health act permits seclusion of involuntarily admitted patients in acute emergency situations, or when it is absolutely necessary to avert danger caused by the patient’s mental illness. Since 2006, a nationwide project aimed at the reduction of the number and duration of seclusion episodes by 10% a year has yielded positive results in one-third of mental hospitals. The Dutch Minister of Health recently advocated a further reduction of seclusion rates by 50% over the next year. We argue that short-term abolition of seclusion is an illusion and that the safety of patients and employees on closed psychiatric wards must be guaranteed. A further reduction in the practice of seclusion requires a major cultural change in psychiatry, adjustment of the law, and the financing of high-care psychiatric wards which are better staffed with appropriately qualified personnel.