Fewer forced admissions due to law reform

In Flanders, the number of forced admissions increased by 53 percent between 2010 and 2022. In Brussels, this increase was even faster, increasing by 50 percent between 2016 and 2023. The legislation regulating these forced admissions dates from 1990. Since 2017, a working group has been working to bring that law into the 21st century. It has created two new instruments for this purpose: ‘clinical evaluation in the emergency procedure for involuntary admission’ and ‘voluntary admission under conditions’.

This ‘clinical evaluation in emergency procedures’ provides for an observation period of a maximum of 48 hours. This observation is done by an interdisciplinary team with a psychiatrist or accredited doctor. He will then draw up a medical report for the public prosecutor’s office and the justice of the peace. Based on that report, the prosecutor will decide whether there will be a forced admission.

The observation can take place in a psychiatric institution or in the psychiatric department of a hospital; In the long term, it should also be possible in other residential institutions, such as a residential care center, a facility for people with disabilities, or even at home, through a mobile crisis team.

The emergency procedure is now ordered by a prosecutor. About 85 percent of forced admissions happen this way. Only after ten days of detention will a justice of the peace decide. As many as 25 percent of forced admissions in 2020 ended on or before that ten-day limit. A large part of those forced admissions would therefore not have been necessary. This is food for thought, according to the working group, because the impact of such a forced admission is very great for the person involved.

Intermediate form

‘Voluntary admission under conditions’ enables an intermediate form between forced admission and voluntary admission. Anyone who says they voluntarily enter treatment can no longer be compulsorily admitted, and that created problems. “Take Yassine Mahi, who stabbed police officer Thomas Monjoie to death at the North Station in Brussels in 2022,” says Raf De Rycke, chairman of the Brothers of Charity and chairman of the working group. Mahi turned himself in to the police earlier that day because he had “developed a hatred for police officers and was thinking about committing an attack.” Mahi wanted to be admitted voluntarily, so the Brussels public prosecutor’s office did not proceed with a forced admission. But he walked away from the clinic, and later that day attacked Monjoie.

In ‘voluntary treatment under conditions’, a patient agrees to a number of conditions, for example regarding residence and the therapeutic agents that will be used. These conditions are recorded in advance in a treatment plan. If they are not observed, the treating physician must inform the public prosecutor. He or she can then decide to convert the voluntary treatment into involuntary admission.

These two new measures are not the only thing that should give the legislation a new shine. A lot of attention is also paid to less stigmatizing language. ‘Mentally ill’ becomes ‘patient with a psychiatric disorder’ and ‘forced admission’ is given the new name ‘protective observation measure’. The rights of patients and their environment also feature more prominently in the updated legislation.

Recipe for misery

Brenda Froyen has already written several books about psychiatry and has been forcibly admitted several times herself. She is cautiously positive about the change in the law: “The intention is clearly to help people. But I see very little change in the use of coercion after a forced admission.” She is referring to the isolation cells and the restraint of patients after they have already been locked up in a psychiatric institution. “It remains unclear to what extent the new rules will make a difference.”

Although there are bright spots: “The report will need to provide better and more detailed motivation. Sometimes there are only a few scribbles in there now.” The chance of more care elsewhere or at home also means steps forward. “Putting people who suffer mentally together can be a recipe for misery. People are not always better off in a crisis department.”

The innovation only has a chance of success if crisis care is further expanded, says Raf De Rycke. In this way he pleads for more high intensive carebeds (called HIC beds for short) in general hospitals.

Federal Minister of Health Frank Vandenbroucke (Vooruit), submitter of the amended law, says that 15 million euros in 28 high intensive careservices has stopped. “We have also strengthened the mobile crisis teams. They will receive additional resources this year (23.9 million euros, ed.) to be able to work even faster and organize the clinical evaluation.”