The Netherlands: Promoting physical and mental wellbeing

The Netherlands’ Ministry of Health, Welfare & Sport is responsible for promoting physical and mental wellbeing, social infrastructure and active lifestyles through participation in sport, as this article details

The Netherlands’ Ministry of Health, Welfare & Sport works to ensure people stay healthy as long as possible, those who are sick are restored to health as quickly as possible, and that people with a mental or physical limitation can participate fully in society.

The ministry’s work centres on three policy areas:

Public health

The ministry encourages people to adopt healthy lifestyles, including exercising more, smoking less, drinking alcohol in moderation, practising safe sex and eating healthily.

It also works with health insurers, healthcare providers and patient organisers to ensure there are sufficient facilities available to people with health issues and that these people have sufficient choice.

Welfare

In collaboration with ministries focused on the economy, education, housing and the environment, the Ministry of Health, Welfare & Sport works to strengthen the social infrastructure that supports those who are not economically independent or who do not take an active part in society. Volunteer work and youth care are key elements of the Netherlands’ social policy.

Sport

Sport is crucial in promoting health, providing social contact and contributing to self-development. The ministry’s mission is to make it possible for everyone to take part in sport.

In addition, it funds top-level sports to help the Netherlands compete on the international stage.

Paul Blokhuis

Paul Blokhuis is the State Secretary for Health, Welfare and Sport. Born in Zuidhorn in November 1963, Blokhuis had previously worked as a Policy Officer for the Reformed Political Federation, later the Christian Union, in the Dutch House of Representatives from 1990 to 2006.

From 2006, he served almost continuously on the municipal executive of the city of Apeldoorn in Gelderland, where he was responsible for welfare, social care, healthcare, the implementation of the Social Support Act, volunteer services and youth care.

He became State Secretary in October 2017 in the third cabinet of Prime Minister Mark Rutte.

Focus on mental health

Under Blokhuis and his predecessors, mental health has been a key area for the ministry.

More than four in 10 Dutch people will experience mental health issues during their lifetime. To help, the government has set up a system of frontline support from GPs and primary and secondary mental health care.

Outpatient treatment is always preferred for people with more serious mental health problems. Admission, including involuntary admission, to a mental health institution is the last resort.

Since January 2014, GPs have received extra funding enabling them to work with other healthcare professionals, such as general practice mental health workers or advising psychologists, to treat people with mild mental health issues. The GP retains ultimate responsibility for the patient.

If a patient’s problems are too complex for a GP or general practice mental health worker to treat, they may be referred to a primary mental healthcare provider or referred directly to secondary care. Other medical professionals, like company doctors and paediatricians, can also refer people to either service.

Primary mental healthcare providers deal with people suffering from mild to moderate mental health issues. Treatment may include counselling from a psychologist or psychotherapist or some form of online support (e-health).

Anonymous e-health

Sadly, one of the biggest barriers to treating mental health issues is overcoming the perceived stigma to reach out for help.

That is why, in 2013, the Dutch cabinet agreed to longterm funding for anonymous e-mental health, based on a proposal by then-Minister of Health, Welfare and Sport, Edith Schippers.

The system is designed to help care providers to continue to treat patients with psychological problems who require care yet are reluctant to seek help, perhaps because they feel ashamed or are afraid of how those around them will react.

Early identification and self-management have proved beneficial to patients with mental disorders. E-mental health is also considered a cost-effective form of treatment.

Community and involuntary care

Those with more serious or complex psychiatric disorders, such as ADHD or anxiety disorder, are referred to as secondary mental healthcare.

People suffering from serious and complex mental disorders are often admitted to a mental health institution. However, research has shown that they would prefer to be treated in their own environment and the government supports a shift towards community-based care wherever possible, such as receiving counselling from a specialised nurse on an outpatient basis.

By 2020, mental health institutions must reduce the number of beds by a third compared to 2008. Health insurers and providers are working together at a regional level to achieve this target.

However, where a person is a danger to themselves or those around them, they may be involuntarily admitted, or committed, to a mental health institution.

The process for involuntary admission is laid out in the Psychiatric Hospitals (Committals) Act, which applies to people suffering from a psychiatric disorder or intellectual disability and people with memory problems or dementia.

Under the act, only institutions designated by the Ministry of Health, Welfare & Sport may admit patients on an involuntary basis. Every patient who is committed to an institution is entitled to a clear description of the treatment they will receive.

New legislation on compulsory care has been put before parliament. If approved, the Psychiatric Hospitals (Committals) Act would be replaced by two new acts: the Compulsory Mental Health Care Act and the Care & Compulsion (Psychogeriatric & Intellectually Disabled Patients) Act.

The separate pieces of legislation have been introduced to better serve the different problems and interests of the two groups of patients currently covered by the Psychiatric Hospitals (Committals) Act: people with psychiatric problems and those suffering from intellectual disability or dementia.

The main elements of the Compulsory Mental Health Care Bill cover compulsory care in community settings, giving patients and their families more rights and a greater say in decisions about their care, compulsory care as a last resort and making aftercare a standard part of treatment.

The main aims of the Care & Compulsion (Psychogeriatric & Intellectually Disabled Patients) Bill are to make compulsory care possible if a person’s behaviour is leading to a serious disadvantage to themselves or others, and to establish clear treatment guidelines for people receiving care at home who are subject to restrictive measures, such as locking doors at night to prevent them wandering.

Last year, working with the Ministry of Justice & Security, the ministry launched a number of pilot projects with care and safety houses to provide an intensive, person-specific approach to get a better picture of the most mentally disturbed people in their region who exhibit different degrees of aggressive, disruptive or dangerous behaviour.

This is a small group within the larger body of people with mental health issues, who do not pose any threat and only need care and treatment, and who require extra attention from all stakeholders, including the police, Public Prosecution Service, healthcare insurers, municipalities, the Dutch Mental Health Care Association and Care for the Disabled.

There is often no, or no longer, a basis in criminal law for the approach towards these people, who consistently refuse the treatment or care they need.

The approach is part of a multi-year plan for care and safety houses covering 2017 to 2020. The pilot projects will develop a personalised approach in which various stakeholders across healthcare, welfare and security collaborate more effectively to form a better picture of this complex group. Care measures can be scaled up or down depending on an individual’s situation.

A “national known persons” check will also be implemented from next year, which will see care and safety houses work together to inform local authorities if a mentally disturbed person moves from one region to another.

The care and safety houses are being linked to the Continuity of Care programme being launched across the country in 2020. The programme includes a field standard lifecycle function, which is designed to bring stability to people in terms of their healthcare, living arrangements, work and daytime activities and debt restructuring.

The issue of monitoring people with severe psychological problems has been highlighted by the Hoekstra Commission’s report into the 2014 murder of former Dutch health minister and pro-euthanasia campaigner Els Borst, who was killed by Bart van U, a man diagnosed with paranoid psychosis in the context of schizophrenia. The commission concluded there had been serious failures by police, the prosecution service and mental health services.

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