What if someone is suicidal and urgently needs care but cannot be admitted anywhere in disability care simply because there is no space? Is temporary placement in a psychiatric clinic allowed at that point? The Supreme Court ruled that it is not. André den Exter, Associate Professor of Health Law at Erasmus School of Law, argues in his opinion piece in Nederlands Dagblad that lawmakers must act swiftly.
No room for appropriate care
The situation is dire: a suicidal patient with an intellectual disability was recommended for hospital admission by doctors. According to the law, this admission had to take place in a facility falling under the Care and Coercion Act (Wzd), which is intended to prevent serious harm such as suicide. However, no such place was available. To protect the patient, nonetheless, admission to a psychiatric institution seemed the only viable option at that moment. The mayor can order a crisis admission for a short period, but this measure only lasts a few days. Such a brief period is usually insufficient to help someone in a vulnerable state truly.
The caring heart versus the judicial heart
To extend a stay in a psychiatric institution, judicial approval is required, and the judge must strictly follow the law. Den Exter explains: "The judge faced a difficult dilemma: either strictly adhere to the law and deny authorization - with all the associated health risks - or accept potential legal objections and allow the stay in a psychiatric clinic, hoping that a suitable place would be found later. The caring heart says, 'necessity knows no law,' but the cold judicial heart ruled otherwise." The Supreme Court concluded that Wzd care may not be provided within the framework of mental health care.
A structural problem
According to Den Exter, it is hard to say how often situations arise in which a patient urgently needs to be admitted to a Wzd facility, but no appropriate spot is available. "I do not know the exact numbers, but this issue definitely exists in practice." The problem is that the current Wzd does not provide for a temporary 'interim solution', such as the one found in the Compulsory Mental Health Care Act. Den Exter explains: "There has been previous criticism about the lack of a legal basis for a 'bridge crisis bed' in disability care. However, nothing was done with that criticism. Judicial compliance keeps the acute bed shortage alive. It is primarily up to care organizations to seek solutions within the care chain to address the scarcity. Additionally, it is the legislator's responsibility to provide a legal basis for a bridging authorization. No one can be lawfully deprived of their freedom without such a legal basis."
Time for action
But what about the patient from Doetinchem? Den Exter writes in his opinion piece: "Returning to the former home situation seems unimaginable - admission was necessary for a reason. Admission to a psychiatric facility is not allowed due to the absence of a psychiatric disorder, so a care provider outside the region must be sought who can provide the necessary care. In the meantime, Minister, please arrange that legislative amendment for temporary mental health admissions in disability care, and do it quickly!"
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Read Den Exter’s opinion piece in the Nederlands Dagblad via this link (in Dutch).
