2.2 Care and coercion The IGZ investigated a sizeable number of individual cases of compulsory treatment in the context of care for the elderly and care for the disabled and also studied the subject of seclusion and the restriction of liberties in these contexts. One of the aspects explicitly included in the supervisory activities by the IGZ in 2014 was the perspective of the citizen. In processing each report, the IGZ considers whether the perspective of the citizen/client was sufficiently heard. Seclusion Seclusion is a very drastic measure containing a significant risk of the patient suffering mental or physical harm. Mental healthcare institutions have been trying to reduce the incidence and duration of seclusion measures since 2002. In 2004, the Dutch Mental Healthcare Association announced it would annually reduce the use of seclusion measures by 10 percent. Between 2006 and 2012, the Ministry of Health, Welfare and Sport supported this ambition by providing additional funding. As the supervision of vulnerable patients and the cutting down on coercion and compulsion are important points of attention to the IGZ, it has been closely monitoring the progress made by mental healthcare institutions to further reduce the use of seclusion measures since 2008. In late 2011, the IGZ, upon completing a long-term investigation, found that the ambitions of the mental healthcare institutions would not be realized. The reduction of the use of seclusion measures was found to stagnate. The IGZ therefore called for all parties in the field to develop standards for effective prevention. However, the multidisciplinary ‘Coercion and compulsion’ guideline the field parties were to draw up failed to appear, while the field standard for intensive care remained but an intermediary step. In consequence, the IGZ announced that it would alter its supervision of the field. The IGZ supplemented the two existing standards prevent seclusion as much as possible, and register each instance of seclusion in accordance with the so-called Argus data set - with two new standards all mental healthcare institutions are to meet: seclusion cannot consist of solitary confinement and in cases of a seclusion measure lasting longer than a week, consultation by independent experts at fixed times is mandatory. In consultation with the field, the IGZ in this connection established an assessment framework in 2012. 66 mental healthcare institutions were inspected in 2013, 2014 and the first quarter of 2015 in connection with monitoring the theme of reducing seclusion in regular mental healthcare. Four institutions were visited four times, and two were even inspected five times. The investigation shows that all mental healthcare institutions inspected meet the four standards for reducing seclusion, but that about one third of all mental healthcare institutions required more time, and more pressure by IGZ, to meet the standard. The most difficult standard for the institutions to meet was that of the independent consultation at fixed times. The IGZ required institutions not meeting the standard to immediately implement improvement measures. The IGZ advised the Minister of Health, Welfare and Sport to impose an order subject to a penalty on two institutions, as they failed to register in accordance with the Argus data set. One institution had a department placed under stricter Inspectorate supervision. 10