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Restriction on restraints in the care for people with intellectual disabilities in the Netherlands: lessons learned from Australia, UK, and United States
- Authors:
- ROMIJN Anita, FREDERIKS Brenda J.M.
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 9(2), June 2012, pp.127-133.
- Publisher:
- Wiley
The use of restraints in the care of people with intellectual disabilities in the Netherlands is regulated by the Psychiatric Hospitals Act. Physical or mechanical interventions may be used to avert aggression and danger to a client or his surroundings. The issue of restrictive practices has attracted considerable attention following a television documentary which revealed excessive use of mechanical restraints on an 18-year old youth. The aim of this article was to provide insight into legislation, protocols, and practices in other countries so as to make recommendations for policy on reducing the use of restraints in the Netherlands. Journal articles and policy reports on national policies and practices for the years 2000-11 were analysed for 3 countries: the United Kingdom, United States, and Australia. The findings showed that, although the use of restraints in the care for people with intellectual disabilities is internationally regulated by the criterion of ultimum remedium, policy is clearly not always in line with practice. Common elements in best practices designed to reduce the use of restraints include: strong leadership in care facilities based on national policy; trained staff; a strict monitoring system; and changes in attitudes on the use of restraints, with restraints being identified as treatment failure.
Client factors as predictors of restraint and seclusion in people with intellectual disability
- Authors:
- SCHEIRS Jan G. M., et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 37(2), June 2012, pp.112-120.
- Publisher:
- Taylor and Francis
In public health care in the Netherlands physical or personal restraint may be applied to reduce the unwanted consequences of a person's actions (such as hurting themselves or others), for example in response to challenging behaviours in residential settings for people with intellectual disability. This study investigated the role played by demographic and psychological variables in predicting the use of restraint. The article reports on the results of analysis of data about 475 adolescent and adult residents of a regional institution for people with intellectual disabilities in the Netherlands, including types and severity of restraint and separation. The study found that 60% of the residents had been treated with physical or mechanical restraint or with seclusion or separation. None of the height, weight, age or length of stay variables were related to the application of restraint. However, several psychological variables were significant predictors: low adaptive functioning, the presence of challenging behaviours (other than actual aggressiveness), and a relatively high intellectual level. Aggressive behaviours played a minor role in predicting restraint.