Dutch Mental Health Care Research Articles

Mental Health Care in the Netherlands

Dutch mental health care has evolved into an extensive system of hospitaland community-based services, including outpatient clinics, day and home treatment, rehabilitation programs, and sheltered living arrangements. However, 16 million people in the Netherlands still occupy a large number of psychiatric beds: about 1 .6 beds in general mental hospitals and psychiatric departments in general hospitals per 1,000 of the adult and elderly population [ 1 ] . This figure is much higher than the 0.4 beds per 1 ,000 in Spain [2], 0.8 in Denmark [3], or 0.9 in Germany, but comparable with the 1.4 and 1.6 beds in Switzerland [4] and France [5], respectively, and lower than the 2.6 beds in Luxembourg [4]. Although most countries reduced the number of beds for psychiatric care considerably (40 percent to 60 percent) in the 1980s, the absolute number of beds in general mental hospitals in the Netherlands has hardly changed over the last 20 years (21,000-22,000) and has decreased only slightly if population growth is taken into account. However, these administrative national statistics show formal bed capacity for inpatient facilities that may not reflect their ac-

Mental health care reform in The Netherlands.

To describe the major changes in mental health care for adults in the Netherlands during the past 25 years. Scientific literature and official documents. Phases of the reform process are the integration of ambulatory services in the early 1980s and the following implementation of community mental health centres (RIAGGs); the differentiation and extramuralization of mental hospitals; the differentiation within the field of living accommodations; and the final fusion process between these three into integrated regional mental health care organizations. Current issues in the development of services are, e.g. the ever growing demand for mental health care, special programmes for defined target populations, legislation and patient rights, rehabilitation and empowerment. The Dutch mental health care system has a low threshold and a comparatively good quality. There is a long-lasting and strong influence of user and family organizations on the content and quality of services. Recently important organizational changes are taking place.

Increasing use of Dutch mental health care: an investigation.

In the Netherlands, a previous study has shown an increase in the 1-year prevalence of patients in mental health care during the 1990s. Though the number of inpatients decreased, this decrease was far outweighed by a large increase of patients in community care, causing an increase in total year prevalence. The current study aimed at an explanation. The Groningen psychiatric case register was used to determine treated incidence and prevalence over a 9-year period for different age groups. Incidence rates proved fairly stable. The increased prevalence was primarily caused by the growing number of existing cases. People had their first encounter with mental health care at an earlier age and remained in care for a larger part of their life. Results indicate that the accessibility of Dutch mental health care was increased by the implementation of community care. In contrast to other countries, Dutch community care lowered the threshold for mental health care utilization without broadening the target group of mental health services.

The nursing process in crisis-oriented psychiatric home care.

Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.

The historiography of Dutch psychiatry and mental health care.

The historiography of Dutch psychiatry and mental health care.

Rehabilitation in Dutch Mental Health Care

Psychosocial rehabilitation is a neglected area in mental health care in the Netherlands. Although this may seem a bold statement, and although there are, of course, exceptions and one may always do injustice to certain individuals, it can generally be said that, until recently by which I mean in the last few yearscare of the chronically mentally ill has not been a widely recognized need, neither in psychiatric practice nor in research, in the Netherlands. My purpose in this brief paper will be to try to find some explanations for this gap in the development of Dutch mental health care.

The Jigsaw Puzzle of Dutch Mental Health Care

(1987). The Jigsaw Puzzle of Dutch Mental Health Care. International Journal of Mental Health: Vol. 16, Trends in Mental Health Care in Western Europe in the Past 25 Years, pp. 152-163.

The changing structure of Dutch mental health care

Current mental health care policy in The Netherlands emphasizes a major shift from intramural to extramural care. A decline in psychiatric hospital admissions is to result from (a) intensified psychiatric care offered by non-residential provider agencies, (b) an increase in sheltered housing and day care capacity and (c) an integral role in mental health care for the general practitioner. To allow for such a far reaching change, fortification of the greatly fragmented non-residential sector of Dutch mental health care was necessary (in 1982 more than 300 agencies in a country of 14.5 million inhabitants). Mergers have recently led to 60 Regional Institutes for Ambulatory Mental Health Care (RIAGG). This amalgamation within the non-residential sector is considered a major step towards the integration of the entire Dutch mental health care system. The article provides insight into the development of mental health care policy in The Netherlands and offers an analysis of the process of merger of non-residential services. As a necessary preface to this material a sketch of the historical and administrative context of Dutch health care is provided.

Mental health care and the opposition movement in the Netherlands

In The Netherlands, there is a more or less recognized movement in the field of mental health care which is referred to as the psychiatric opposition movement or the patients movement. The nucleus of the dutch movement consists of patients and ex-patients. As far as mental health professionals are participating in the movement, they do so as more or less passive supporters of a movement dominated by patients and ex-patients. This article is dealing with two questions. The first question is how and to what degree the opposition movement in The Netherlands has succeeded in breaking through or at least questioning the closed nature of Dutch mental health care system. The second question will be whether the dilemma between resistance and dependence in the position of patients and ex-patients is visible in the activities of the opposition movement, and whether this dilemma acted as an obstacle to their efforts to influence the mental health care debate in The Netherlands. An effort is being made to answer this question by describing the position of the opposition movement with respect to the Insanity Law and with respect to the organization of mental health care. In conclusion, three stages were found to be crucial in the development of Dutch opposition movement. 1. (1) In the 1970s, the opposition movement appeared to operate within the borders of a closed system in which the medical profession had a high degree of autonomy. 2. (2) By the end of the 1970s, a shift could be detected in the opposition movement from the old desire to work within the system to a new desire to alter the system as such. 3. (3) Since 1980, it has been possible to detect a third development. The existence of the mental health care system as a social institution has been critically appraised to propagate the de-institutionalization of the existing system of clinical psychiatry.