I feel pretty much ashamed of the fact that I haven’t written on this blog about the Dutch isolation cell controversy that’s arisen over the past two weeks, even though I did blog about it extensively on my Dutch healthcare blog. Not that it wasn’t an issue before – it’s been known forever that, in the Netherlands, psychiatric patients are put into solitary confinement far more often than in neighboring countries -, but the recent death of a patient locked up in an isolation cell and the suicide of another patient in the same clinic, sparked a lot of media coverage on living conditions and quality of care in psychiatric hospitals in general and isolation rooms in particular.
One significant problem is that there is not enough staff and staff are underqualified. When I mentioned it to a nurse, he denied it, but I’ve seen an alarming increase in time-out uses since we’ve been structurally understaffed. One nurse told me, when I asked whether my own time-out policy could be terminated, that time-out was needed “if you need more care than we can provide”. Oh well, does that say something about my mental state or about your staffing? The time-ut policy was terminated, but one never knows for how long.
Another issue is that people in isolation rooms cannot be supervised adequtely if there’s not enough staffing. When the nurses don’t have the time to respond to every call in a timely manner, or to check on the patient regularly, it’s no wonder that health or safety issues may go unnoticed.
But another part of the story is really an attitude problem. Isolation should not, and cannot legally be used as punishment, but that doesn’t mean that it won’t happen. It is, actually, only allowed to prevent or avert a situation where the patient causes a threat to himself, other patients or staff. Since when is nagging at other patients or staff, talking to oneself in an irritable manner, or slamming a door (one of my own supposed reasons for time-out), dangerous? Obviously it is not appropriate, but “inappropriate” is not the same as “dangerous”. And what in the world does a time-out policy do about someone “wandering orientationlessly” outside, as I’m reported to have done last June and which was used as the excuse for re-introducing the time-out policy. I used to think that my doctors were always right when they talked about “safety” and “danger” and I must have a really screwed conception of these terms. Now my understanding may indeed be somewhat screwed, but absolutely not in the huge way that my time-out policies have gotten me to think. And if my doctors ever read this and think I’m seriously mistaken, then finally *explain* to me why I am dangerous, and don’t dismiss the matter with an authoritarian “No arguing”.