"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

Abstract

Background: The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction.

Methods: A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required.

Results: A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2^nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation.

Conclusion: By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.

Keywords: Mental health; Mental health reform; Mental health services; Public mental health; Recovery college; Social care; Social trials.

Fig. (1)

Current state of fragmented care. The mental health care system in the Netherlands can be challenging for individuals to navigate due to its regulated market health care system that creates bureaucratic complexity and separates social care from health care. Additionally, the mental health care system's focus on DSM-diagnoses and evidence-based symptom reduction may lead to a narrow approach to mental health care, which overlooks the broader social and contextual factors influencing individuals' well-being. Fragmentation of services and selective patient selection by providers further exacerbate the issue. The municipal public health service (GGD) is responsible for promoting and protecting public health at a local level, with the OGGZ task focusing on identifying and supporting vulnerable individuals with complex psychosocial or psychiatric needs who may not seek help independently. eCommunities like psychosenet.nl and proud2bme.nl offer accessible online support and digital interventions for individuals experiencing psychosis or eating disorders, respectively, breaking down stigma and isolation often associated with mental health issues and demonstrating the potential of digital platforms to complement traditional mental health care services and enhance public mental health. The Netherlands' social care system supports vulnerable individuals and promotes well-being through a range of services, with responsibility largely lying with municipalities to ensure tailored, community-based approaches. The lack of integrated collaboration between mental health care and social care is a pressing problem, given the fact that mental health care consumption in the Netherlands is strongly driven by socioeconomic factors [26, 27]. Recovery colleges focus on empowering individuals to develop self-management skills, build resilience, and foster personal growth, providing a safe, inclusive, and supportive environment. The GP serves as the primary healthcare provider and gatekeeper for specialist services, including mental health care, with the POH-GGZ providing support in assessing, treating, and referring patients with mental health concerns. Addiction services offer outpatient, inpatient, and community-based treatments while learning disability services offer assessments, personalized support, therapy, and guidance for individuals with learning disabilities and their families. The complementary and alternative medicine sector operates alongside conventional healthcare, offering a range of therapies and treatments outside of mainstream practices. Informal mental health care in the Netherlands encompasses a diverse range of non-professional support systems, including religious institutions, voluntary organizations, resource groups, family members or relatives, and community centers, that play a crucial role in promoting well-being and assisting individuals with mental health needs.

Fig. (2)

GEM model of public mental health collaboration, and main qualitative changes.

Fig. (3)

Change strategy in regions of GEM social trial.

Fig. (4)

Benchmarking mental health service indicators at the small-area level (4-digit postal code; municipal boundaries in green) using national data 2015-2020.