Annual Report 2015 not all behaviour was properly recognised, it is possible that physical restraints or seclusion were implemented unnecessarily. Nor was sufficient consideration given to first applying a psycho-social or behavioural intervention, thereby preventing having to use physical restraints or seclusion. The IGZ was required to perform enforcement activities at a couple of institutions, also because their policy and practice with respect to the restriction of freedom were inadequate. Similar shortcomings were identified by the IGZ when it investigated problem behaviour by persons suffering from dementia. Institutions varied in their efforts to analyse the problem behaviour of a client suffering from dementia. At half of the institutions, no efforts were made to identify the causes of problem behaviour. All institutions inspected used treatments involving psychoactive drugs. The use of such drugs was not always known to all staff. At most institutions, an insufficiently wellconsidered and, in particular, too informal an evaluation was performed to assess the effectiveness of a treatment involving psychoactive drugs. In 2016, too, the IGZ will review the implementation of the Psychiatric Hospitals (Compulsory Admission) Act with respect to the care provided to the disabled and the elderly. Mental healthcare On 4 June 2015, the IGZ published its "Report on the investments by mental healthcare institutions to reduce the use of seclusion measures; further action required to meet ambitions". This report showed that mental healthcare institutions had, over the past few years, implemented many improvements to prevent and further reduce the use of seclusion measures. However, there were some differences in the speed by which the mental healthcare institutions implemented improvements. A small group of institutions was constantly working on effecting improvements and using standards featuring an intensive, person-oriented approach that went beyond the standards used by the IGZ for its study. The number and duration of the seclusion measures used had gone down further at these institutions and many seclusion rooms had been put out of service. About one third of the institutions were less rapid with implementing these standards and they needed more time and supervision by the IGZ to improve matters. Six of the institutions required a great deal of time and pressure by the IGZ to implement the desired improvements. In May 2015 and October 2015, the IGZ organised two invitational conferences with all parties in the field, for the purpose of jointly laying down a new assessment framework. This framework allows mental healthcare institutions to reduce the use of both seclusion and segregation measures. All mental healthcare institutions are currently working on implementing this new assessment framework. The IGZ in the last quarter of 2015 inspected eight mental healthcare institutions where it expected, on the basis of various sources of information26, that the risks of seclusion measures being used on patients overly quickly or for a longer period or of patients being faced with overly restrictive house rules was high. During these eight inspections, the IGZ assessed seven compulsory treatments against the provisions of the Psychiatric Hospitals (Compulsory Admissions) Act and fifteen uses of seclusion measures against the four standards for reducing the use of such measures. Two of the seven compulsory treatments were performed without observing due care, the IGZ found. Both treatments took place within the same 18 Table of Cont