"It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Back to table of contents Previous article Next article LettersFull AccessCreating Barriers to Mental Health Care in the Netherlands: ReplyBelinda R. Bruwer, M.B.ChB., M.Med. (Psych.), and Soraya Seedat, M.Med. (Psych.), Ph.D.Belinda R. BruwerSearch for more papers by this author, M.B.ChB., M.Med. (Psych.), and Soraya SeedatSearch for more papers by this author, M.Med. (Psych.), Ph.D.Published Online:14 Jan 2015https://doi.org/10.1176/ps.62.9.pss6209_1106aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We thank Dr. Hovens and Dr. van der Ploeg for their interesting and valuable remarks regarding barriers to mental health care in the Netherlands. The points that they highlight are extremely valid; structural barriers will likely increase significantly if access to mental health treatment becomes even more difficult for financial reasons. Even though attitudinal barriers emerged in our study as the more prevalent barrier, we would like to emphasize again that structural barriers may further impede mental health treatment once attitudinal barriers are overcome. It is of great concern that people seeking treatment for mental illness in the Netherlands are being discriminated against and further marginalized.Fiscal austerity measures across Europe, and more globally, only serve to widen the treatment gap, which in low- and middle-income countries is now 70% for people with schizophrenia (that is, only 30% of those with schizophrenia receive treatment) and 98% for mood disorders (1). The World Health Organization's analysis of mental health services found a distinct positive relationship between treated prevalence rates for mental disorders and country-level income—a pattern evident across low-, middle-, and high-income countries (1). Another finding was the striking disparity in spending on mental health services in low- and middle-income countries—only 3 cents per capita in low- and middle-income settings and 70 times higher in high-income countries. Furthermore, the vast majority of spending on mental health services was found to occur in psychiatric hospitals, leaving community mental health services seriously underresourced.Consistent with the concerns that Dr. Hovens and Dr. van der Ploeg raise about the negative impact of affordability on accessibility of mental health care is the paradoxical finding that emerges from these cross-national analyses: where there is more poverty, people are more likely to pay for mental health care out of their own pockets. On the African continent more than 50% of countries do not have social insurance schemes. To illustrate this more concretely: both antipsychotic and antidepressant medications are more expensive in lower- and middle-income countries than in upper-middle-income countries.Very recently, a consortium of clinicians, researchers, and advocates embarked on a research prioritization exercise to identify global grand challenges in addressing the scourge of mental disorders in order to improve the lives of people with mental illness (2). One of the top 25 challenges they identified is the need to “create parity between mental and physical illness by investing in treatment, prevention, research and training.” Realizing this goal will require a substantial shift in thinking and commitment to equitable funding for mental health services by health ministries around the world.References1 Saxena S , Lora A , Morris J , et al.: Mental health services in 42 low- and middle-income countries: a WHO-AIMS cross-national analysis. Psychiatric Services 62:123–125, 2011 Link, Google Scholar2 Collins PY , Patel V , Joestl SS , et al.: Grand challenges in global mental health. Nature 475:27–30, 2011 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 62Issue 9 September 2011Pages 1106-1107 Metrics PDF download History Published online 14 January 2015 Published in print 1 September 2011

Back to table of contents Previous article Next article LettersFull AccessCreating Barriers to Mental Health Care in the Netherlands: ReplyBelinda R. Bruwer, M.B.ChB., M.Med. (Psych.), and Soraya Seedat, M.Med. (Psych.), Ph.D.Belinda R. BruwerSearch for more papers by this author, M.B.ChB., M.Med. (Psych.), and Soraya SeedatSearch for more papers by this author, M.Med. (Psych.), Ph.D.Published Online:14 Jan 2015https://doi.org/10.1176/ps.62.9.pss6209_1106aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We thank Dr. Hovens and Dr. van der Ploeg for their interesting and valuable remarks regarding barriers to mental health care in the Netherlands. The points that they highlight are extremely valid; structural barriers will likely increase significantly if access to mental health treatment becomes even more difficult for financial reasons. Even though attitudinal barriers emerged in our study as the more prevalent barrier, we would like to emphasize again that structural barriers may further impede mental health treatment once attitudinal barriers are overcome. It is of great concern that people seeking treatment for mental illness in the Netherlands are being discriminated against and further marginalized.Fiscal austerity measures across Europe, and more globally, only serve to widen the treatment gap, which in low- and middle-income countries is now 70% for people with schizophrenia (that is, only 30% of those with schizophrenia receive treatment) and 98% for mood disorders (1). The World Health Organization's analysis of mental health services found a distinct positive relationship between treated prevalence rates for mental disorders and country-level income—a pattern evident across low-, middle-, and high-income countries (1). Another finding was the striking disparity in spending on mental health services in low- and middle-income countries—only 3 cents per capita in low- and middle-income settings and 70 times higher in high-income countries. Furthermore, the vast majority of spending on mental health services was found to occur in psychiatric hospitals, leaving community mental health services seriously underresourced.Consistent with the concerns that Dr. Hovens and Dr. van der Ploeg raise about the negative impact of affordability on accessibility of mental health care is the paradoxical finding that emerges from these cross-national analyses: where there is more poverty, people are more likely to pay for mental health care out of their own pockets. On the African continent more than 50% of countries do not have social insurance schemes. To illustrate this more concretely: both antipsychotic and antidepressant medications are more expensive in lower- and middle-income countries than in upper-middle-income countries.Very recently, a consortium of clinicians, researchers, and advocates embarked on a research prioritization exercise to identify global grand challenges in addressing the scourge of mental disorders in order to improve the lives of people with mental illness (2). One of the top 25 challenges they identified is the need to “create parity between mental and physical illness by investing in treatment, prevention, research and training.” Realizing this goal will require a substantial shift in thinking and commitment to equitable funding for mental health services by health ministries around the world.References1 Saxena S , Lora A , Morris J , et al.: Mental health services in 42 low- and middle-income countries: a WHO-AIMS cross-national analysis. Psychiatric Services 62:123–125, 2011 Link, Google Scholar2 Collins PY , Patel V , Joestl SS , et al.: Grand challenges in global mental health. Nature 475:27–30, 2011 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 9 September 2011Pages 1106-1107 Metrics PDF download History Published online 14 January 2015 Published in print 1 September 2011

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

In light of the rising costs of health care, the Netherlands has introduced regulated competition into its health care system from 2006 onwards. In addition, it is trying to contain the costs with the gradual introduction of a number of austerity measures. This chapter looks at these developments from the perspective of the internationally guaranteed human right to health, thereby paying particular attention to the dimension of ‘access to health care’ under the right to health. An assessment is made of the legal entitlements to health care, and the recognition of the right to health care in the Netherlands. Subsequently, the Dutch health care system is analysed in light of an important component of the human right to health, i.e. the ‘AAAQ’ requirements, which stipulate that health care services have to be available, accessible, acceptable and of good quality. This will be followed by an analysis of the governmental ‘obligation to protect’, in the light of which attention will be paid to accountability mechanisms for addressing possible failures to realise the right to health (care) in the Netherlands. The overall aim of this chapter is to illustrate how from the perspective of the right to health a developed country like the Netherlands tries to cope with a number of serious challenges in the health sector. Our main findings are that while the international right to health is not given much recognition in the Netherlands, the notions underpinning this right are embedded in Dutch law, policies and practice. In terms of health outcomes, issues of concern are the rising socio-economic health inequalities, which raise the question of how such inequalities can best be tackled, for example by improving the living conditions of disadvantaged groups within the population and by placing more emphasis on prevention. Furthermore, health care privatisation and the recent cuts in health care expenditure raise some issues with regard to the ‘AAAQ’, for example in terms of geographic accessibility and affordability of care. When it comes to accountability and participation in the Dutch health care system, the problems are not so much a lack of mechanisms, but rather a lack of coordination and efficiency.

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Digital Medicine – The New Frontier for AI in Healthcare

Opportunities in mental health services research.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Own contribution in costs for mental health care will not exclude clients with minor mental problems but leads to a decrease of clients with the lowest income In 2011 an own contribution in costs for specialized mental health care was considered by health authorities. This was meant to exclude clients with minor mental problems from specialized mental health care. The branch organization of mental health care in the Netherlands (Dutch Association of Mental Health and Addiction Care) has held an online survey among clients in specialized care in November 2011. With this survey the Association intended to estimate intentions to lower the use of specialized mental health care. Results are based on 4996 completed surveys. 70% of the respondents reported an intention to lower their use of care facilities as a result of the own contribution in costs. The intention to abstain from future care was directly related to the income situation. Perceived seriousness of illness and perceived necessity of care was not related to the intention of care decrease. The largest expected decrease in care was found in youth mental health care and addiction care. We conclude that the measure (that has not been effectuated) would not have led to a decrease of clients with the least serious mental health problems but to a decrease of clients with the lowest income, whatever their problems are.

Integrated-Care Models Increase Psychiatrists’ Impact