Risky procedures: Experiences and views of psychiatrists and views of management of mental health care institutions

Abstract

Objective: To evaluate the functioning of the reserved procedures regulations in the Netherlands, which are included in the Individual Health Care Professions Act (1997), the experiences and views of psychiatrists and the views of management of mental health care institutions were studied with regard to risky procedures in mental health care.

Method: Postal questionnaires were sent to all 105 mental health care institutions in the Netherlands and a random sample of 300 psychiatrists.

Results: Response rates were 60% for the psychiatrists, 67% for the psychiatric hospitals and 62% for the ambualtory care institutions. According to 32% of the psychiatrists there were procedures in mental health care that are not legally regulated, but are so risky that they should only be carried out by or on the orders of psychiatrists. Two thirds of the psychiatrists (66%) thought that psychotherapy should be classified as a reserved procedure. The majority of the psychiatrists (65–96%) were of the opinion that assessment of the need for seclusion, treatment in a crisis situation and the termination of treatment can only be safely carried out by or on the orders of psychiatrists. Although 60% of the psychiatrists working in an institution had protocols, 72% were of the opinion that these guidelines were not, or partially satisfactory. Over two thirds of the institutions (69%) thought that the reserved procedures regulations provide adequate protection for patients.

Conclusions: More attention should be paid by legislators, institutions and professional organisations to risky procedures in mental health care, in particular in the field of diagnostics and therapeutic procedures.