[Decision making and the future of mental capacity. Steps towards an uncertain future within the context of CRPD]. / Beslissingsbekwaamheid? Met het VN-verdrag Handicap naar een onzekere toekomst.

Background  Mental capacity, the criterion used today to determine who can make decisions independently, is under pressure from the United Nations Convention on the Rights of Persons with Disabilities. Aim  To outline the prevailing view, the view of the UN Convention and a middle ground. To formulate steps to apply the spirit of the UN Convention today. Method  Essay starting from the most relevant international human rights sources within the United Nations and the Council of Europe, supplemented by secondary literature on these sources. Results  The UN Convention abandons mental capacity as the criterion to determine whether a patient can make decisions autonomously. At the same time, it rejects any form of coercion applied directly or indirectly because of mental illness. Conclusion  The UN Convention does not offer a clear alternative, so the future is uncertain. Nevertheless, the important principles of the UN Convention should not be forgotten; they can already be implemented today by being aware of the role of human rights in mental health care, by placing the quality of decision-making at the center and by making less and more conscious use of coercion.

[Flemish guideline for the prevention and use of seclusion and restraint]. / Vlaamse richtlijn voor de preventie en het gebruik van afzondering en fixatie.

BACKGROUND: International consensus states that seclusion and restraint should only be applied as briefly and as little as possible. However, audits by the Care Inspectorate show that this is not always the case in Flemish mental health care (MHC). AIM: To describe the development of a multidisciplinary guideline for the prevention and application of seclusion and restraint in inpatient MHC, underpinned by both clinical-scientific and legal evidence. METHOD: The GRADE method formed the basis for the development of the guideline. To integrate both types of evidence, two research phases were added. This article provides an overview of the challenges involved in implementing this interdisciplinary method. RESULTS: There are gaps in both clinical-scientific and legal evidence. Nevertheless, the study resulted in a comprehensive guideline because we underpinned the recommendations with practice- and experience-based expertise of the Flemish stakeholders, and integrated the clinical-scientific and legal evidence. CONCLUSION: Focus on implementation research and a clear legal framework for Flanders are necessary to safeguard the (human) rights of MHC users, also in the event of aggression and escalation.