Methodological issues in monitoring the use of coercive measures

PurposeIn many European countries, initiatives have emerged to reduce the use of seclusion and restraint in psychiatric institutions. To study the effects of these initiatives at a national and international level, consensus on definitions of coercive measures, assessment methods and calculation procedures of these coercive measures are required. The aim of this article is to identify problems in defining and recording coercive measures. The study contributes to the development of consistent comparable measurements definitions and provides recommendations for meaningful data-analyses illustrating the relevance of the proposed framework.MethodsRelevant literature was reviewed to identify various definitions and calculation modalities used to measure coercive measures in psychiatric inpatient care. Figures on the coercive measures and epidemiological ratios were calculated in a standardized way. To illustrate how research in clinical practice on coercive measures can be conducted, data from a large multicenter study on seclusion patterns in the Netherlands were used.ResultsTwelve Dutch mental health institutes serving a population of 6.57 million inhabitants provided their comprehensive coercion measure data sets. In total 37 hospitals and 227 wards containing 6812 beds were included in the study. Overall seclusion and restraint data in a sample of 31,594 admissions in 20,934 patients were analyzed. Considerable variation in ward and patient characteristics was identified in this study. The chance to be exposed to seclusion per capita inhabitants of the institute's catchment areas varied between 0.31 and 1.6 per 100.000. Between mental health institutions, the duration in seclusion hours per 1000 inpatient hours varied from less than 1 up to 18 h. The number of seclusion incidents per 1000 admissions varied between 79 up to 745. The mean duration of seclusion incidents of nearly 184 h may be seen as high in an international perspective.ConclusionCoercive measures can be reliably assessed in a standardized and comparable way under the condition of using clear joint definitions. Methodological consensus between researchers and mental health professionals on these definitions is necessary to allow comparisons of seclusion and restraint rates. The study contributes to the development of international standards on gathering coercion related data and the consistent calculation of relevant outcome parameters.     

The influence of staffing levels on the use of seclusion

This study focussed on the relationship between the use of seclusion and staff characteristics, such as number of nurses on shift, male-female staff ratio, level of education and level of work experience. A retrospective analysis of staff characteristics was applied to administrative data from ten wards in four mid-sized general psychiatric hospitals in the Netherlands. The data show that two variables were associated with seclusion rates: the male-female staff ratio and the variability in team's work experience. More female and less male nurses in a shift and less variability in team's work experience predicted an increase in seclusion rates.     

Black Petes & Black Crooks? Racial stereotyping and offending in the Netherlands

In the popular Dutch tradition of Sinterklaas, the caricature of his helper ‘Zwarte Piet’ [Black Pete] is often of a black-faced white person. The representation of this character has been surrounded by controversy in Europe and abroad. The following paper discusses these recent controversial media stories in the Netherlands and Western Europe along with the historical context of this character. We also make an argument about how the pervasive imagery in news, television, and theatre of people of color in the Netherlands may be influencing crime statistics by creating and encouraging negative views of ‘the other’. In the Netherlands, Dutch Caribbean and Surinamese first-generation immigrants compared to white, native Dutch are over-represented in official arrest and prison statistics. We theorize that the reasons for this noticeable overrepresentation in crime statistic is it at least in part due to a societal stigma of ‘the other’ and racial profiling of black ethnic minorities.     

How do disciplinary tribunals evaluate the "gut feelings" of doctors? An analysis of Dutch tribunal decisions, 2000-2008

A sense of alarm, which is a form of "gut feeling" sometimes plays a part in the decisions of medical disciplinary tribunals in The Netherlands. Since these judgments are regarded as setting standards for professional attitudes in The Netherlands, the question arises how Dutch tribunals have evaluated gut feelings, and how tribunals in other European countries deal with them. An exploratory study searched two Dutch digital databases (2000-2008) and asked 26 national representatives of the European General Practice Research Network for information about the role of gut feelings in tribunals' decisions. A sense of alarm was mentioned in judgments in 34 Dutch cases. Defendants were hardly ever reproached for missing the correct diagnosis, but mostly for not acting in a professional manner. The sense of alarm was referred to as a diagnostic tool to assess a patient's situation, although the judgments indicate that it must be followed by further diagnostic steps. The role of gut feelings in decisions of disciplinary tribunals in Europe is unclear. The authors conclude that the sense of alarm as a diagnostic tool has been taken seriously by Dutch tribunals. Its timely development is considered to be an element of the professional standards for doctors.     

Transforming Prevention Systems in the United States and The Netherlands Using Communities That Care

Josine Junger-Tas introduced the Communities That Care (CTC) prevention system to the Netherlands as a promising approach to address the growing youth violence and delinquency. Using data from a randomized trial of CTC in the United States and a quasi-experimental study of CTC in the Netherlands, this article describes the results of a comparison of the implementation of CTC in 12 U.S. communities and five Dutch neighborhoods. CTC communities in both countries achieved higher stages of a science-based approach to prevention than control communities, but full implementation of CTC in the Netherlands was hampered by the very small list of prevention programs tested and found effective in the Dutch context.     

A comparison of seclusion rates between intellectual disability and non-intellectual disability services: the effect of gender and diagnosis

Introduction: The use of seclusion as a means of managing the extreme behaviours forensic patients in secure settings is a controversial yet often common practice, despite there being little evidence that seclusion as a practice has any significant therapeutic value for the patient. The aim of this study was to explore the use of seclusion and whether this differs as a function of gender and diagnosis across secure services. Method: This study collated data from 11 medium and low secure hospitals that admit male and female patients, with some services providing services for patients with intellectual disability (with or without co-morbid disorders), and others for patients with mental illness and/or personality disorder only. Results: Both gender and diagnosis were associated with differential seclusion rates. Seclusions were three times longer for patients in the non-ID compared to the ID service. Male seclusions (for any diagnosis) were around twice as long as those in female services. Female ID patients spent significantly less time in seclusion compared to other groups. Female ID was associated with two to three times the number of seclusion events per patient compared to other groups. No statistically significant association between the type of service and the reason for a patient being secluded. Conclusions: A range of organisational factors that determine the use and duration of seclusion are cited and merit further exploration. High rates of psychiatric co-morbidity and the complexity of patients admitted to services may also mediate risk and use of seclusion. The study supports the use of early intervention techniques and the adoption of positive behaviour support.     

Routine Activities and Deviant Behaviors: American, Dutch, Hungarian, and Swiss Youth

The current investigation examined cross-national similarities and differences in routine activities, measures of deviance, and their relationship in representative samples of 7,000 adolescents aged 1519 years (mean age: 17.5 years) from Hungary, the Netherlands, Switzerland, and the United States. For the majority of youth, most of their time was spent in solitary activities, followed by peer activities, community/sports activities, and family activities; Hungarian youth reported spending a much greater amount of time with the family than adolescents from other countries, while Dutch youth spent far more time in solitary activities than their peers. Rates of total deviance were remarkably similar for American, Dutch, and Swiss youth; Hungarian youth reported substantially lower rates than all other adolescents. Finally, findings indicated that routine activities accounted for 18% for males and 16% for females of the variance explained in total deviance. Furthermore, with the exceptions of alcohol and drug use, country had very little or no explanatory power in deviance. The current study suggests that the utility and the explanatory power of the routine activities framework replicates across national boundaries.     

"Culture of death" in The Netherlands: Dutch perspectives

During the summer of 1999, extensive interviews with some of the leading authorities on euthanasia policy were conducted in the Netherlands. They were asked: Daniel Callahan argues that there is a 'culture of death' in the Netherlands. What do you think? The majority of interviewees disagreed with the statement. They said that the Netherlands is not fundamentally different than other countries. If at all, the Dutch culture is open and tolerant, welcomes debates and plurality of views, and physicians are decent people who wish to help their patients, not to kill them. A small minority acknowledged that there is some truth in Callahan's observations, arguing that the Dutch actually do not welcome critique and are quite conservative in their liberal attitude toward euthanasia.     

The European Sourcebook of Crime and Criminal Justice Statistics: A New Tool in Assessing Crime and Policy Issues in Comparative and Empirical Perspective

Theories which suggest a relationship between crime or criminal justice variables on the one hand, and variables related to criminal justice policies on the other hand, cannot be tested without reference to historic or comparative data. Since international comparisons offer the most powerful test of such theories, policy-related research in Europe has suffered, so far, from a lack of valid comparative data. Whether crime data from different countries are comparable, has always been subject to controversies. In the case of the European Sourcebook of Crime and Criminal Justice, a network of specialists was established under the auspices of the Council of Europe in order to assess the validity of the data. Although some problems in cross-country level comparisons could not be settled, the European Sourcebook offers comparative data on 36 Member States of the Council of Europe on a variety of subjects (offences and offenders known to the police; prosecution, convictions, sentences, and corrections; survey data; and indications on manpower and budgets of police forces, prosecutors, and corrections).     

Sudden infant death syndrome (SIDS)--standardised investigations and classification: recommendations

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.     

The toxicological challenges in the European research project DRUID

Within the epidemiological studies of the integrated European research project DRUID (Driving Under the Influence of Drugs, alcohol and medicines), 13 laboratories from across Europe will analyse whole blood, oral fluid (OF) or urine from the general driving population and injured drivers. To ensure the comparability of toxicological results from the different studies, the collection of samples, analytical methods, target analytes and analytical cut-offs have been standardized for all laboratories involved.Target analytes were selected based on suspected impairing effects and prevalence. Twenty-three drugs are included in the ‘core list’ for which analysis is mandatory: ethanol, amphetamine, MDMA, MDA, MDEA, methamphetamine, cocaine, benzoylecgonine, THC, THC-COOH, 6-acetylmorphine, diazepam, flunitrazepam, alprazolam, clonazepam, oxazepam, nordiazepam, zolpidem, zopiclone, lorazepam, morphine, codeine and methadone. Additionally, 28 other drugs will be analysed in 1–12 countries.All whole blood samples are collected in glass Vacutainer-type tubes containing sodium fluoride and potassium oxalate. Based on a comparative study of 10 collection devices, it was decided to collect oral fluid using the Statsure™ device. Since only a small sample volume is available (5–10 mL blood and 1 mL oral fluid), all laboratories have to develop methods for simultaneous detection of the target analytes. All laboratories agreed to use either LC–MS–MS or GC–MS in SIM-mode. Proficiency testing for both blood and oral fluid are organized.Analytical cut-offs were established for the core list based on those used in ROSITA-2, SAMHSA cut-off values for oral fluid and recommendations from an expert meeting in Talloires.Because of practical and legal considerations, different sample types are used: whole blood, serum/plasma and oral fluid. Literature on correlation between analyte concentrations in these body fluids is limited, which makes several comparisons of study results difficult: (1) comparison of epidemiological (blood, oral fluid and urine) and experimental studies (serum and plasma) performed in DRUID and (2) comparisons within the epidemiological studies themselves (most countries: oral fluid in road-side survey, blood in hospital studies).A combination of literature findings, new findings from DRUID and semi-quantitative results will likely have to be used to solve these problems.     

Family breakdown in nineteenth- century Netherlands: Divorcing couples in The Hague

As in other European countries, divorce became a social issue in the Netherlands from the beginning of the 1880s on. At the same time, divorce rates rose considerably. To examine whether the public debates were reflected in the behavior of Dutch couples, an empirical study was conducted of divorce in the second half of the nineteenth century. Use was made of a case-control research design in which the social characteristics of all marriages which ended in divorce were compared with those of a random sample from the marriages which ended in widowhood. The author analyzed a group of 2,300 marriages contracted in The Hague from their inception until their dissolution by death of divorce. All migrants were followed to their new place of residence. Multivariate (proportional hazards) analysis showed that the highest probability of divorce was found among persons who had already gone through a divorce before. Other factors related to divorce were high mobility, low ages at marriage, and large age and religious differences between spouses. Higher social classes had relatively high divorce risks.     

Developments in legal and medical practice regarding the unborn child and the need to expand prenatal legal protection

Developments in legal and medical practice in the Netherlands give rise to questions regarding the legal position of the unborn child. This article provides an overview of these developments and argues--in view of developments in other countries--that current Dutch legislation regarding the unborn child is not up to date. In effect, the article challenges the idea that the actual legal protection of the unborn child under positive Dutch law can be considered proportionate, even sufficient. To support this view the author will show that abortion is not the only matter in which clarity as to the legal protection of the viable unborn child is required. This signalisation provides good cause to reconsider the Dutch perspective on the matter, thus offering a point of reference to countries with a similar interpretation of what constitutes an appropriate legal protection of the unborn child.     

Social Work and the Security Issue in the Netherlands and Belgium

Over the past years security has become a central issue in political discussions both in the Netherlands and Belgium. This has led to the setting of new governmental schemes in urban areas that rely upon the commitment of social workers to a large extent. Besides that, a number of new professions linked to social intervention have appeared. The purpose of this article is to analyse the emergence of security as an issue and the effects of the new governmental schemes in the field of social work, and to compare the political and social backgrounds, how security is dealt with and the effects on social work in Belgium and the Netherlands. The general assumption is that the practice of social professions tends to a new balance between change and control, the two usual poles of social work, at the expense of emancipatory practices towards marginalised people. In other words, it is wondered whether the action of social workers is to put in place a system of control and risk prevention as a mix of social work and people policing. The article shows that the development in this direction in the two countries is similar, in spite of significant background differences.     

INTIMACY AND HOMICIDE: COMPENSATING FOR MISSING DATA IN THE SHR*

The Supplementary Homicide Report (SHR) of the FBI's Uniform Crime Reporting Program remains the most accessible and widely used database on lethal violence in the United States. However, researchers using this database must address the problem of missing data, which typically is the result of the failure to file, inconsistent filing of reports to the FBI by local police agencies, or incomplete records about the characteristics of specific incidents of homicide (particularly, missing information about perpetrators), even when reports are filed. Williams and Flewelling (1987) proposed methods of compensating for missing information, and this paper revisits their assessment by again determining the extent of the problem and the consequences of adjusting for it. Alternative methods are proposed and analyzed, with a focus on relationship‐specific rates (i.e., rates of family, intimate nonfamily, acquaintance, and stranger homicide). The implications of the results for further use of the SHR are discussed.     

The other side of the Anne Frank story: The Dutch role in the persecution of the Jews in World War Two

Contrary to their historical reputation there were only a few Dutch citizens who rescued Jews during World War II by providing their homes as a shelter. Of all the West European countries occupied by the Germans, the number of Jewish casualties was the highest in The Netherlands. Before the occupation there were approximately 140,000 Jews living in The Netherlands, and of that total at least 109,000 were murdered. When the war was over many war criminals and Nazi collaborators were punished. This did not include, however, Dutch civil servants and many of the police and train conductors who were all part of the Holocaust machine. They were recruited from the large middle-ground of a population of mainly bystanders. In addition, Dutch criminology has been conspicuously silent about the Holocaust. Therefore, I shall discuss the following issues as contributory to the Holocaust: (1) the denunciation process; (2) the attitude of The Netherlands' bureaucracy in general; and, (3) the negative impact of the actions of officials in positions of the highest power such as the Queen (who fled to Britain), members of the Supreme Court and Chiefs of Police.     

Fare dodging and the strong arm of the law

In this paper we discuss a controlled experiment on the enforcement of sanctioning for fare evasion in trains in the Netherlands. The experiment ran for 2 years, and the extent to which sanctions were effectively imposed was compared for non-chronic fare evaders in two regions. Travellers caught without a ticket who had not paid on the spot were divided into two conditions. In the (regular) control condition, the Dutch railways attempted to recover the cost of the unpaid ticket, plus a small penalty, followed by regular, civil law, debt collection procedures. In the experimental condition, the efforts by the Dutch railways were followed by penalty collection procedures by the Dutch Ministry of Justice’s fine collection agency. The results under the experimental condition were worse than those under the standard procedure. Both conditions have (often lengthy) follow-up procedures entailing criminal prosecution, which are not reported upon here. We discuss the implications and the questions that these findings raise.     

Effective Detention: The Development of a Policy

The Dutch Prison Service developed a new policy on indoor employment programmes. The development of this policy, the definition of these programmes and the chosen methodology of Individual Employment Counselling is described. Also some examples of good practice are given. We learned a great deal from good practice, from external advisors, from co-operation with partners like employers, probation services, local authorities and from comparable programmes in other European countries. The development of these programmes was supported by changes in the prison service, economic growth in the Netherlands, a new employment policy initiated by the Dutch government, and by sub-financing of the European Social Fund. Future challenges are: better matching of prisoners (their motivations, their capacities and handicaps) with the programmes, further development of co-operation with partners and the implementation of a good monitoring system.