S27.01 - Integrated care in Europe - The Dutch model

Abstract

Mental health care in the Netherlands generally has been characterized by a relatively high number of hospital beds, and moreover during the last 15 years by an increase of sheltered living accommodation (also beds) in the community – without decreasing significantly the hospitals beds. Psychiatric hospitals have survived and transformed themselves into large organizations providing various forms of out-, day- and inpatient treatment programmes and sheltered living arrangements in a circumscribed geographical catchment areas. Deinstitutionalization has a special meaning in this context: no actual blocking of hospital admissions like in Italy or closing buildings like in the USA but more in the sense of gradually decreasing numbers long stay patients, of shortening duration of admission stay, providing within days a kind of aftercare (continuity of care), extending sheltered living accommodation in the community by independent institutes and outreaching community care. This process of extramuralization seems to be ‘frustrated’ or maybe ‘facilitated’ - depending on the eye of the beholder - by recent changes in the organization and financing of mental health care. Not the government but the providers and the insurance companies – and to a lesser extent the client resp family movement – will be decisive for the outcome. This could have far reaching consequences for the ultimate goal of integration of care.