Submission on the Netherlands to the Committee Against Torture for the 50th session of the CAT-committee (6 May - 31 May 2013)
Torture and ill-treatment in mental health care in the Netherlands
Submitted by: Stichting Mind Rights Eindhoven, the Netherlands www.mindrights.nl
This submission is supported by:
World Network of Users and Survivors of Psychiatry (WNUSP)
European Network of (Ex)-Users and Survivors of Psychiatry (ENUSP)
Pan African Network of People with Psychosocial Disabilities (PANUSP)
International Disability Alliance (IDA)
Author: Jolijn Santegoeds, Stichting Mind Rights
Date: 19 April 2013
Contents:
Notes before reading
Proposed recommendations on the Netherlands
Summary
1. Introduction on language and definitions
1.1 Scope of mental health care in the Netherlands
1.2 Psychosocial disability, mental health and care
1.3 The Recovery-approach
1.4 Backgrounds and paradigms in mental health care in the Netherlands
1.5 General introduction on human right themes and misperceptions in mental health care in the Netherlands
1.5.1 Substituted decision making in mental health care in the Netherlands
1.5.2 Forced interventions in mental health care in the Netherlands
1.5.3 Humane care is possible in mental health care in the Netherlands
2. Mental health care
2.1 Worrying signs indicating human rights violations in mental health care
2.1.1 User experiences
2.1.2 Mental health and suicide in the Netherlands
2.2 Organisation of mental health care in the Netherlands
2.2.1 Overall organisation of care levels in mental health care in the Netherlands
2.2.2 Organisation of legal measures allowing for forced treatment in mental health care in the Netherlands
2.2.3 Organisation of mental health care for children and youth in the Netherlands
2.3 Problems of mental health crisis-interventions in the Netherlands
2.3.1 Waiting lists: Support in a mental health crisis in the community is often not available
2.3.2 Superficial practices of crisis-interventions by mental health care services in the Netherlands
2.3.3 Avoiding waiting lists by increasing court orders
Children with psychosocial problems get detention instead of care
2.3.4 Pressuring for voluntariness at forced interventions
2.4 Forced admissions in mental health care institutions in the Netherlands
2.4.1 Dutch mental health care institutions
2.5 Forced treatments in mental health care institutions in the Netherlands
Note: Coercive interventions are misplaced measures in mental health care
2.5.1 Decision-making regarding coercive care interventions in the Netherlands
2.5.2 Seclusion and solitary confinement in mental health care in the Netherlands
A. Seclusion (separation)
B. High Care/ Intensive Care-Units
C. “Afzondering” (segregation)
D. Confinement in regular room
E. National projects to reduce seclusion by 10% annually (2008-2013)
F. Long term seclusion still happens
G. Public outrage in 2008 on seclusion in mental health care in the Netherlands
H. International jurisprudence on Dutch seclusion
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2.5.3 Forced medication in mental health care in the Netherlands
A. “Pressured decision making” B. Community Treatment Orders in the new law proposal “Mandatory mental health care”
C. International jurisprudence on forced medication
2.5.4 Fixation / physical restraints in mental health care in the Netherlands
A. Public outrage in 2011 on fixation of children with disabilities in the Netherlands
B. Still no solution in 2013!
C. International jurisprudence on physical restraints (fixation)
2.5.5 “Visitatie”: Forced body cavity search (on children)
A. Body cavity search / physical force/ being touched in mental health care
B. Body cavity search on (innocent) children in detention
B. Manual body cavity search with physical force still happens in prison settings
2.5.6 Special concerns about Dutch residential elderly care institutions
2.6 Alternatives to coercive care interventions
2.6.1 Alternative: more social support
Alternative approach: Dealing with dangerous behaviour and crisis-situations
2.6.2 Alternative approach More prevention of crisis-situations in mental health care
2.6.3 Alternative approach: Better handling of crisis-situations in mental health care
2.6.4 Barriers to the actual implementation of social alternative approaches
2.6.5 Projects to reduce seclusion in mental health care in the Netherlands
2.6.6 Physical alternatives to seclusion rooms: The limitations of sensory support
2.6.7 Alternative approach to fixation/physical restraints
2.6.8 Systemic barriers to the implementation of alternatives to coercion
2.7 Related law reforms in the Netherlands
2.7.1 Planned ratification of CRPD ? and the strange reservation to allow torture
2.7.2 Law reform on forced treatments: More options for forced treatments
2.7.3 Alternative law-proposal: more social support (Family Group Conferencing)
2.7.4 Torture prevention mechanisms in the Netherlands
3. Forensic care (TBS)
3.1 Organisation of mental health care in detention
3.2 Goal and scope of Forensic mental health care (TBS)
3.3 Court orders for Forensic care (TBS)
3.4 TBS-clinics/ Forensic Psychiatric Clinics
3.4.1 Long-stay TBS in forensic psychiatric clinics in the Netherlands
3.5 Forced interventions in TBS/Forensic care
3.6 Recidivism (relapse rate)
Annex 1: Introduction of relevant international standards
Annex 2: User experiences
Annex 3 : Personal experiences of the author