As part of a national policy to reduce the use of seclusion in the Netherlands, High and Intensive Care (HIC) Units were developed. HIC Units are acute admission wards focusing on ‘restoring and maintaining contact and crisis prevention’ (Submission 27). The Units require a multidisciplinary team (psychiatrists, nurses, psychologists, service users) of a sufficient size, who must be specifically trained in crisis management, handling aggression and suicidal behaviour. One aim of the HIC Units is to reduce the use of seclusion and reduce the number of beds devoted to mental health care (Submission 27). The Units were developed in 2013 by a multidisciplinary group of Dutch experts, including service users and family representatives (Submission 27).

A specific architectural environment is cultivated that includes one-person bedrooms, large and light living rooms and the availability of outdoor spaces. The Units are designed to offer a welcoming and healing environment (Submission 27).

The techniques used include methods such as a careful assessment of the risk of escalation and setting up an individual crisis plan in consultation with the person concerned and their relatives. This plan describes how escalation can be prevented. In the event that stress and anxiety arise, a person is never left alone. Collaboration between staff members, the outpatient team, users and relatives is central. In addition, frequent risk assessment enables staff members to act proactively and prevent escalation (Submission 27). Reportedly, the initiative has led to an overall reduction of seclusion, but seclusion is still being used as a practice.

According to Mental Health Europe (Mental Health Europe, 2019, pp.3-4):

The [HIC] Units show promising results in terms of the use of seclusion in inpatient wards. Moreover, the decrease of seclusion rates is not associated with an increase of forced medication. Finally, if coercion is used, it must be documented and this data is regularly discussed among staff members in order to further assess how to reduce coercion with the aim of eliminating this practice.

For more information, see Mental Health Europe, 2019 pp.3-4; van Melle et al., 2019