General hospital psychiatry in the Netherlands

Abstract

From the beginnings of general hospital psychiatry (GHP) and consultation-liaison (CL) psychiatry in the Netherlands in the 1970s, this field has attracted growing attention and interest. Political and social developments in the late 1980s and early 1990s, however, have resulted in a serious setback for GHP from which it is only recently recovering. Since the release of the new mental health act in 1984, mental health care policy was focused at bbringing psychiatry closer to society.Q This was mainly done by striving toward integration of all psychiatric services into the so-called regional mental health centers. This not only applied to psychiatric hospitals and social psychiatric services, but also to GHP and CL psychiatric services. Although in the beginning, GHP was not much affected by this process, in later years, new legislation puts pressure on GHP wards and CL services to participate. This policy has had serious consequences for GHP. Perhaps the clearest example of this is the decree issued by the government in 1993, that in case of new building or renovation of psychiatric hospitals, they are obliged to form mental health centers and merge with psychiatric wards in general hospitals and CL services. In spite of the fact that psychiatric wards in general hospitals were the most efficient services, being responsible for 33% of all acute admissions, whereas having only 7% of clinical capacity [1], this efficiency was sacrificed for the bureaucratic idee fixe of integration and forced merger of services. Many psychiatric wards were moved out of the general hospital and reallocated to these regional mental health centers, thus, losing all the advantages of their location inside the hospital. Because of this, the number of independent psychiatric wards in general hospitals has declined more then 50%