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‘Patient-led action plan’ to appeal compulsory treatment orders – the Netherlands

This practice functions as a form of appeal process available to a person who is subject to an involuntary psychiatric intervention (Submission 30). However, it is a process that places the onus on the individual herself or himself to propose an alternative care arrangement and gives discretion to approve or reject the alternative plan with the ‘medical director’ that issued the original involuntary intervention. In the Netherlands, medical directors can authorise involuntary psychiatric interventions.

Under this appeal process, individuals who are deemed by a medical director to require involuntary psychiatric intervention are given a letter indicating that an involuntary order is being prepared. The letter states that the person may draw up an action plan, including setting out how she or he wishes to avoid compulsory medical care. The person must submit this plan in writing within three days of receiving the letter from the medical director. The medical director will decide within two days whether the patient will be given time to do so. If so, the patient will have two weeks' time to draw up the action plan. In this case, the medical director postpones the preparation of the care authorisation temporarily. A template is available for those wishing to make such an action plan, which lists the steps she/he can take for making the plan. The document can be downloaded from the service website, or she/he can ask the medical director for such a document.

The patient can draw up the action plan together with health professionals, friends or family (Submission 30). The patient can also ask a patient advocate or a lawyer for advice. In the action plan, the person can describe what she or he wants to do and what care she or he would like to receive to avoid compulsory medical care. This description can cover various kinds of care, including clinical care, family-based care or social care. The person can also request other support or services, such as domestic help, municipal services, pastoral care, and day care.

The medical director assesses the person’s action plan and asks for a medical statement from an independent psychiatrist. The public prosecutors can stop the preparation of a care authorisation if the medical statement reveals that compulsory medical care can be prevented using the action plan. If the action plan is not sufficient to avoid compulsory medical care, the medical director will continue preparing the care authorisation.

The medical director can also decide at an earlier stage – that is, before the two weeks for drawing up the plan have elapsed – that she or he will continue preparing the care authorisation. The medical director can do so if drawing up the action plan is not proceeding quickly enough or if postponing the preparation of the care authorisation is no longer possible because of the serious harm or perceived danger of the situation. Before doing so, the medical director will discuss it with the patient and their representative. The patient will also be notified about the decision in writing. No empirical information was available at the time of writing concerning the impact of this appeal process on rates of involuntary intervention.