[Assessment of decision-making competence; article for educational and training purposes]. / Wilsbekwaamheid beoordelen.

Care providers are frequently confronted with complicated questions about decision-making competence. This article offers tools to help them to deal with those questions. We also look closely at the underlying legal aspects of competence, how and when competence should be assessed, who is responsible for this assessment and which tools are available for this process.

[Involuntary admission of addict during early pregnancy]. / Wet BOPZ toegepast bij vroege zwangerschap van verslaafde.

A 30-year-old cocaine-dependent woman was 16 weeks pregnant. Because of possible endangerment of the fetus, an involuntary provisional admission was authorized. Of particular interest is the application of the Dutch Act on Formal Admissions to Psychiatric Hospitals for the primary diagnosis 'addiction' and the fact that the fetus was regarded as a legal 'other'. In severe cases of addiction combined with pregnancy an earlier intervention is needed and arrangement of accelerated legal custody of the newborn before birth should be considered. For the protection of the unborn, we advocate a stricter application of the United Nations Convention on the Rights of the Child. Information for addicted women with preconception counselling can help prevent a compulsory admission.

[Seclusion: a medical and political problem]. / Separeren: medisch en politiek probleem.

Seclusion, i.e. locking up psychiatric patients in safety rooms as a coercive measure, is common practice in the Netherlands. The Dutch mental health act permits seclusion of involuntarily admitted patients in acute emergency situations, or when it is absolutely necessary to avert danger caused by the patient's mental illness. Since 2006, a nationwide project aimed at the reduction of the number and duration of seclusion episodes by 10% a year has yielded positive results in one-third of mental hospitals. The Dutch Minister of Health recently advocated a further reduction of seclusion rates by 50% over the next year. We argue that short-term abolition of seclusion is an illusion and that the safety of patients and employees on closed psychiatric wards must be guaranteed. A further reduction in the practice of seclusion requires a major cultural change in psychiatry, adjustment of the law, and the financing of high-care psychiatric wards which are better staffed with appropriately qualified personnel.