Market forces in the mental health care sector ‘not working’

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Within four weeks, mental healthcare institutions and health insurers must draw up a plan to guarantee a minimum number of ‘treatment places’ for complex psychiatric patients. Many of them now fall outside the boat because mental healthcare institutions find them too complicated.

This was announced by State Secretary Paul Blokhuis (Public Health, ChristenUnie) on Wednesday during the debate in the Lower House about the stalled mental health care (mental health care). Ninety thousand people are waiting for treatment, ten thousand of whom are longer than the legal norm (a maximum of seven weeks).

If that plan does not succeed within four weeks, the State Secretary will draw up and enforce it himself.

Glue the care

The reason for this is persistent reports about those waiting. One of them, the 26-year-old Charlotte Bouwman, has been camping for nine days before the Ministry of Health, Welfare and Sport in The Hague, with her dog, to draw attention to the long waiting lists. She has been waiting for a suitable place for over two years. She would finally be helped when it appeared in December that the institution where she could go had stopped with that specific treatment. She was on a waiting list with twenty others.


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Bouwman is happy with Blokhuis’s commitment, she says in a response, but she believes more needs to be done. “There must also always be room for people in acute need, just like there is in the emergency department for people with physical complaints.” Blokhuis did refer to this in the debate: “Four hours on hold if you call the emergency service . ”And according to Bouwman, there must be a help desk that helps patients who end up on a waiting list. Blokhuis said that there is a “unit for complex care issues” at the Ministry of Health, Welfare and Sport, but that nobody knows them and that he does not do much. According to him, that must change.

Complex patients are financially uninteresting for many institutions

In the parliamentary debate, where GroenLinks, the SP and the PVV in particular were very critical of the persistently long waiting lists, Blokhuis said that the market operation in the mental health care for complex patients ‘does not work’. He spoke of ‘market failure’ because complex patients need complicated, long-term treatments. And for many institutions that need to remain financially healthy, they are uninteresting. “Complex patients are not attractive for business operations.”

Of the fifteen main diagnoses in mental health care, five are, according to Blokhuis, “complex”: dissociative disorder, anorexia, complex trauma, addiction and autism combined with post-traumatic stress. Patients who fall under one or even more of these official categories are sometimes sent away for convenience. There are also too few treatment places for them.

‘Too complex’ patients end up on waiting list

Last week, care providers and patients presented the manifesto Glue the care about the “silent disaster in psychiatry”. She described how patients – young and old – who are found to be ‘too complex’, end up on a waiting list. This manifesto has been electronically signed 64,000 times.

Professor of Psychiatry epidemic Jim van Os pointed out that mental health care cannot cope with the enormously growing demand for psychological and psychiatric help. “The question is endless. 40 percent of the population do get significant complaints somewhere in life: panic or anxiety attacks or depression. Every year, 20 percent of the population suffer from something at that time. The mental health care cannot cope with that question; we can help no more than 7 percent of the population. And then the Netherlands still has a large mental healthcare compared to other countries. The 3 percent of the population who are really chronically ill, including the complex cases, that should be our priority. ”He also said that scientific evidence shows that patients benefit mainly from a good relationship with a therapist – even if they suffer from three disorders at the same time. According to Van Os, the trend among psychiatrists to “specialize” into one specific disorder is counterproductive.

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