Compulsory Psychiatric Treatment at Home in the Netherlands: A Case Report

An important aim of the new mental health act implemented in the Netherlands in 2020 was to shift the focus from hospitalization to treatment. The act provides an option for patients' compulsory treatment at home (CTH). Unlike compulsory community treatment (CCT), which allows mental health workers to hospitalize patients involuntarily if they do not comply with treatment. CTH is not provided elsewhere in the world. This case report concerns a patient who, to avoid hospitalization, received CTH in the form of compulsory medication and was able to recover at home. Retrospectively, she and the mental health team both positively evaluated this use of CTH. The parties involved all concluded that CTH restricted the patient's autonomy less than hospitalization, it did not influence the therapeutic relationship, and the CTH could be delivered in a way that it did not compromise participants' safety. This case report shows that, in some situations, CTH can avoid hospitalization. Care should nonetheless be taken to assess its appropriateness, to discuss any preconditions, and to evaluate the use of compulsory treatment in dialog with the patient and significant others.