De Very Intensive Care afdeling: beveiliging en behandeling hand in hand
From the experience with a very intensive care unit for mentally ill delinquents is concluded that maximum security and individual treatment can be melted together succesfully. Very intensive care is defined as involuntary care in an adapted sociotherapeutic network with further individual treatment modalities, for patients with a strong tendency for destructive acting-out. In the handling of aggressive behaviour there are the following structural points of reference:
- strict individual treatment on a small closed unit;
- the staff operates as a team and not individually;
- clinical psychotherapy is separate from the unit;
- all interactions between patients are controlled;
- patients have disposal of the necessary information and decisions;
- patients are not forced to any activities.
To stop and to treat the threat of aggression or the aggressive outbursts a regime of consecutive interventions is known to staff and patients:
- confinement on the unit;
- separation in one's room;
- isolation in an isolation-chamber;
- forced medication.
With emphasis is put forward that there exists a distinction between care and treatment: care means that the patient is held to prevent further pathological behaviour, treatment that the patient in a conscious or unconscious way can make use of the therapeutic environment. What is forced upon him is the custody and not the change of personality.