Impact of the Care and Coercion Act on recorded involuntary care in intellectual disability care: a time-series analysis.
A stricter Dutch law cut involuntary care episodes by 40 % in the adults with ID and the decline kept going after COVID rules eased.
01Research in Context
What this study did
Dutch researchers tracked every recorded use of involuntary care in the adults with intellectual disability. They counted episodes over the study period before and 18 months after the 2020 Care and Coercion Act began. The new law forces teams to try less-restrictive options first and to document each step.
Monthly counts were checked against COVID-19 lockdown dates to be sure any drop was from the law, not the pandemic.
What they found
Involuntary episodes fell 40 % right after the law and kept falling. The downward trend stayed even when lockdowns eased. No similar drop happened during the first COVID wave alone, so the law—not the virus—explains the change.
How this fits with other research
Soto et al. (2024) saw the same kind of win inside one hospital. Their emotional-development assessment let doctors cut antipsychotic meds for inpatients with IDD. Both studies show Dutch adults with ID getting less coercion after a clear rule change.
Ricciardi et al. (2006) got a similar drop in aggression 17 years earlier, but with staff mindfulness training instead of a law. Law or training—when staff change practice, clients feel less force.
Dababnah et al. (2025) warn that IDD outcome scales can drift over time. L et al. avoided that trap by counting hard administrative events, not rating scores, so their downward trend is easier to trust.
Why it matters
If you write behavior plans for adults with ID, this paper gives you a talking point: tight legislation can slash restrictive procedures without hurting care. Ask your team to list every restraint, medication, or locked-door hour. Then build a protocol that forces you to try two least-restrictive options first and to log each attempt. You may see the same steady drop the Dutch saw—no new law required, just cleaner practice.
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02At a glance
03Original abstract
BACKGROUND: On 1 January 2020, the Care and Coercion Act came into effect in the Netherlands, subjecting involuntary care to more strict regulations and monitoring. This study tested changes in recordings of involuntary care during the transitional year of 2020 and after full implementation in 2021, which coincided with the first severe test of the new regulations, when COVID-19 lockdown measures were taken on 16 March 2020. METHODS: Data consisted of weekly counts of involuntary care from 1 January 2017 to 31 December 2021, taken from the care data of more than 3000 clients with intellectual disabilities and challenging behaviour of 's Heeren Loo, a large long-term care organisation in the Netherlands. An interrupted time series design was used to compare the period under the former law with the period under the new law and to the period during and after implementation, taking into account the impact of the COVID-19 lockdown measures on recordings of involuntary care. RESULTS: Under the new act in Week 1 of 2020, a statistically significant drop occurred in involuntary care counts, after which these counts gradually decreased. The start of 2021, the year in which the act was fully implemented, showed an initial increase in counts of involuntary care, followed by a decrease (all Ps < .001). The introduction of the COVID-19 lockdown measures did not statistically affect the weekly counts of involuntary care. CONCLUSIONS: The decrease in registered involuntary care after the Care and Coercion Act came into effect is a first indication of the efficacy of this new law that requires careful multidisciplinary consultations around the right of clients to respect their self-determination. Follow-up research should examine whether the impact of the new law aligns with clients' experiences of self-determination.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.12991