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BACKGROUND: In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card. AIM: To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz. METHOD: A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews. RESULTS: Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged. CONCLUSION: Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.

Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system.To describe the characteristics of patients treated within the measure of reimbursement of PCP.A total of 350 patients participated in an online survey at the start of their PCP treatment within one of the 31 mental healthcare networks in Belgium. Besides sociodemographic characteristics, they were questioned about their mental disorders, suicidality, service use, and delays in seeking treatment.Almost 90% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing suicidal thoughts and/or behaviors (STB) in the last 12 months. For 49.1% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 6 years.PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB, and many of them have been in mental health treatment before. These findings raise the question whether PCP fits the needs for the patients that are treated.

Backgroundnbsp;nbsp; The societal discourse concerning gender(diversity) is changing rapidly and this trickles down to our consultation rooms. Most requests for gender-affirming medical care (GAMC) are well-considered and evidently necessary. In more complex presentations, however, challenges may arise. Aimnbsp; To provide insight into clinical challenges in decision-making regarding GAMC. Methodnbsp; Discussing relevant literature by means of a clinical vignette. Resultsnbsp; Dilemmas may arise in assessing competence to give consent to treatment. In differential diagnosis, it may be challenging to discern the interaction between gender incongruence and co-occurring mental conditions. Conclusionnbsp; It is unethical to prima facie deny access to GAMC to those presenting with co-occurring mental health concerns and/or challenges in decision-making capacity. For this population, specialist care and comprehensive deliberation are indicated. To arrive at good care and decision-making, sufficient knowledge and sensitivity among, and cooperation with other mental health services is indispensable.

Women with mental health issues may wish to get pregnant. In some situations a pregnancy is contra-indicated or not be in the best interests of the future child. This article analyses the way treating physicians may assist these women and, if needed, treat these women by using somatic of psychiatric care. This on the basis of the Dutch Patients' Rights Act and mental health legislation. The recent Dutch Mandatory Health Care Act provides physicians more opportunities to act in comparison with the previous situation.

In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card.To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz.A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews.Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged.Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.

LGBT+ (lesbian, gay, bisexual, transgender and other) youth have a higher risk to experience trauma and develop mental health problems including anxiety, depression and suicidality then their straight cisgender peers.To explore underlying factors for this elevated risk. To provide insight in LGBT+ inclusive mental healthcare.Overview of the literature and explanatory models. Contemplation of the current youth mental healthcare and advices for clinical practice.The elevated risk for mental health problems in LGBT+ youth could be explained by minority stress, trauma, social exclusion and family problems. For these young people, the current healthcare system lacks sufficient knowledge, skills, safe environment and availability of expert care. Interventions that could contribute to inclusive care are: signaling the link between mental health problems and LGBT+ identity, using inclusive language; supporting youth in exploring their own identity; ensuring safety; support coping with minority stress; an organizationscan exploring institution's environments; providing both general and expertise care.

BACKGROUND: In January 2020 the Compulsory Mental Healthcare Act (Dutch: Wvggz) was implemented. The Wvggz details the rights of patients with mental illness who require compulsory care. The law aims, amongst others, to improve the legal rights of patients and those close to them, for example by enabling the possibility to draw up their own action plan (AP) or care card. AIM: To explore what health care professionals think of the possibilities for involvement by patients and those close to them, enabled by the Wvggz. METHOD: A qualitative study in which health care professionals were interviewed about the possibilities for involvement by patients and those close to them. We used thematic analysis to study the data from the interviews. RESULTS: Health care professionals were positive about the idea to involve patients and those close to them, though they indicated that patients and those close to them were already involved before the law came into effect. The main difference was that their involvement was more documented, for instance patients can write their own AP or fill out a care card. Health care professionals mentioned that both the AP and the care card offer the possibility for patients and those close to them to express and realize their wishes. On the downside, not all patient groups were able to draw up their own plan of action. Furthermore, according to the health care professionals, both the action plan and care card could give patients the false impression that their wishes can always be acknowledged. CONCLUSION: Health care professionals mention that patients and those close to them were already involved before the law came into effect. However, the ways in which their involvement is arranged and documented are different.

Over the past decade, shocking incidents have driven a debate about how to handle persons exhibiting mentally confused behaviour who commit crimes. In response, Amsterdam launched a pilot project in 2017 to improve collaboration between the judicial system and mental health services at police stations to achieve a more appropriate rapport between criminal justice and care.To describe the pilot project and it's initial results.We describe the establishment of the pilot project, as well as the results of an initial evaluation of the characteristics of the incoming persons and the handling of the arrests. In a separate experiment we evaluated how information about the results of a psychiatric consultation affected decisions about the handling of cases by the public prosecutor's department.While respecting legal constraints, it proved possible to exchange information between the public prosecutor's department and the mental health care system. In one-third of the cases, the public prosecutor adapted the decision about the handling of the case after being informed about the psychiatrist's assessment. Four-fifths of the incoming persons were male and only one-third lived in Amsterdam. One-third had a psychotic disorder and more than one-third a substance-related disorder. Compulsory admissions were ordered for 15% of the suspects who were assessed. After assessment, both treatment and penalties were ordered for one-third.The professionals involved thought the new approach was positive. However, it is still too early to draw any conclusions about the effects. The unusual profile of the cohort makes it clear that the police, the judicial system, the mental health care system and municipal organisations are faced with a complex challenge in their efforts to reduce the number of incidents with confused suspects on the long term. Further research is required in order to determine the social and psychiatric characteristics that predict recurring contacts with the police.

The consultation function of centers of excellence is still used to a limited extent. In this article we explain possibilities and contributions of highly specialized consultation to support standard mental healthcare by means of vignettes. Case descriptions from the consultation practice of four centers of excellence are presented. More intensive use of consultation options by mental health care providers can help improve the quality, efficiency and effectiveness of care.

BACKGROUND: Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. AIM: To describe the characteristics of patients treated within the measure of reimbursement of PCP. METHOD: A total of 350 patients participated in an online survey at the start of their PCP treatment within one of the 31 mental healthcare networks in Belgium. Besides sociodemographic characteristics, they were questioned about their mental disorders, suicidality, service use, and delays in seeking treatment. RESULTS: Almost 90% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing suicidal thoughts and/or behaviors (STB) in the last 12 months. For 49.1% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 6 years. CONCLUSION: PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB, and many of them have been in mental health treatment before. These findings raise the question whether PCP fits the needs for the patients that are treated. ispartof: Tijdschr Psychiatr vol:64 issue:9 pages:595-603 ispartof: location:Netherlands status: published

Achtergrond Ondanks een hoog voorkomen van psychiatrische aandoeningen bij asielzoekers, is het gebruik van psychiatrische zorgverlening erg laag. Barrières in de toegang tot de zorg spelen hierin mogelijk een belangrijke rol. Doel Onderzoeken welke barrières er zijn voor zowel patiënt als zorgverlener binnen de ggz voor volwassen en adolescente asielzoekers in hoge-inkomenslanden. Methode Een narratief literatuuroverzicht, op basis van een systematische evaluatie van de wetenschappelijke literatuur. Resultaten In een narratieve synthese van de resultaten identificeerden we zes categorieën barrières: gebrek aan kennis van het gezondheidszorgsysteem, taalbarrières, verschillen in opvattingen en in verwachtingen van ggz, gebrek aan vertrouwen in autoriteit, en structurele moeilijkheden. Conclusie Verschillende interventies zijn mogelijk om deze gevonden thematische barrières aan te pakken. Verder onderzoek naar behoeften en interventies is aangewezen en dit met specifieke aandacht voor de Belgische en Nederlandse context.

A key ethical issue in psychiatry concerns the relationship with patients. A central dilemma is that experiential knowledge (regarding existential recovery) and professional knowledge (the framework of specific-medication-for-specific-brain-disorder) are not easily integrated into a practice of co-creation.To describe the status quo in health care and science.Qualitative review.Under the influence of critical psychiatry ('antipsychiatry'), the recovery movement, the voice hearing movement and open science, the patient voice has gained influence while the scientific framework of academic psychiatry/psychology is critically re-examined. Co-creation in mental health services is limited whilst parallel development is more successful. For example, experience-based recovery academies are developing primarily in the domain of social care whilst evidence-based specialist treatment remains the norm in mental health services. There is, however, a growing call for co-creation around recovery-oriented work in the mental health sector, despite limited institutional readiness. There is also a growing movement of user research responding to epistemic injustice and driving patient-driven innovations - although sometimes on the basis of appropriation without source awareness.Experiential knowledge is growing as the theoretical framework of psychiatry is in the process of change. This creates the conditions for co-creation of a new values-driven psychiatry.

Most research focuses on the impact of COVID-19 for the general population. People with mental health problems may suffer even more from its consequences.Measuring mental health, experiences with outpatient care and government measures of 105 people in mental health care in the Northern Netherlands during the first wave of COVID-19.Anonymous, online survey among people in care with autism- or FACT-teams in the Northern Netherlands between July-September 2020.Few participants reported recent COVID-19-related symptoms (n=2); no participant had lab-confirmed COVID-19. Both positive (clear world, tranquility, few stimuli: 28%) and negative experiences (missing face-to-face contact with mental health care professionals: 22%) were reported. Although there was some fluctuation in happiness, the average happiness score did not change due to the first wave. Three-quarters were satisfied with their mental health care. Although in-person contact with mental health care professionals was missed, the continuation of care through (video)calling was appreciated. One third reported an increased or new care need in mental health symptoms or daily functioning. The 'physical' government measures were considered pleasant and doable, but 'social' measures were harder. Newsletters with practical information about the consequences of the measures for personal healthcare were appreciated.The results show a nuanced picture of how outpatients experienced the first wave of COVID-19. Continued monitoring is important, as long-term impact of COVID-19 cannot be predicted.

Patients with mental health disorders often have difficulty perceiving associations between multiple symptoms, such as inter-relations between somatic and psychological symptoms. This difficulty may be particularly challenging in patients with complex disorders. Individual dynamic network analysis may provide novel diagnostic and treatment possibilities because it can create a starting point for a personalized approach in complex cases in tertiary mental health care expert centres, where standard protocolized interventions were insufficiently effective.To explore the possibilities provided by dynamic network technologies in the care of patients in tertiary care expert centres.Overview of these possibilities, with a focus on somatic symptom disorder.Intensive longitudinal data can be obtained using a short and personalized questionnaire that is presented via a patient's smartphone a few times per day during several weeks. These data are then converted to patient-specific dynamic symptom networks using time series analysis. These networks display how variations over time in somatic and mental symptoms and other factors (such as specific situations) mutually influence each other in daily life. They also provide information about cause-effect associations.Dynamic symptom networks provide insight into the associations between symptoms and other factors and can be used to personalize treatment goals and interventions in tertiary care expert centres. Furthermore, these networks create opportunities to examine the (patient-tailored) effects of personalized interventions.

Background A more preventive and proactive approach in youth mental health care can contribute to reduce the severity of psychological problems in young people and help to reduce the risk on treatment resistance. Aim To show opportunities to organize youth mental health care more proactively. Method Discuss new approaches based on existing literature and examples from clinical practice. Results It is essential that young people receive treatment that is appropriate for the severity of their problems. Early detection and prevention can be systematically carried out in collaboration with public health service and schools. In addition, it is imperative that young people receive appropriate (specialized) mental health care based on their prognosis. Conclusion Committing to the right care at the right time is essential to prevent the development of co-morbidities, stagnation in development tasks and therapy resistance. Tijdschrift voor psychiatrie 63(2021)2, 111-114.

Quantification of population-level socioeconomic-demographic factors impacting onset and course of health care consumption can help health care commissioning and public health planning.br/AIM: To analyse associations between mental health care, medical-specialist care and general practitioner (GP) care with regional socioeconomic-demographic factors. Two cost parameters were examined: (i) absolute costs; and (ii) relative costs, defined as the proportion of PC3-level costs attributable to outliers (defined as costs above the 80th percentile - as a proxy for care intensity).br/METHOD: Analysis of Vektis data over the period 2014-2017 in the age range of 18-65 years.br/RESULTS: Mental health care cost variation was for 28% reducible to (younger) age, urbanicity, PC3-level ethnic density and PC3-level socioeconomic-demographic factors. Variation in medical-specialist care and GP care costs were reducible principally to (older) age. Costs attributable to outliers ranged from 34% for GP care to 55% for mental health care. Socioeconomic-demographic factors explained a substantial part of the variation in the PC3-level proportion of outlier costs for mental health care (31%), medical-specialist care (43%) and GP-care (33%).br/CONCLUSION: Analysis of the degree and pattern of socioeconomic-demographic factors impacting mental health care can inform both public mental health planning and mental health care commissioning. Tijdschrift voor psychiatrie 63(2021)1, 39-47.

An increasing number of studies in people with mental illness have demonstrated the efficacy of lifestyle interventions for both mental and physical health. However, implementing and sustaining such interventions in routine mental healthcare is challenging.br/AIM: To describe implementation barriers and facilitators of various lifestyle interventions in routine mental healthcare.br/METHOD: In this paper we summarise the results of three recent doctoral theses and provide recommendations for routine mental healthcare.br/RESULTS: Enabling factors and barriers for successful implementation appeared to be universal across various settings and patient populations. Mental healthcare professionals and patients appreciated and supported the lifestyle interventions. A lack of priority, recognition and support on the organisational level were reported as barriers in all the studies. Addressing various lifestyle behaviours simultaneously (e.g. physical activity and diet), personalised to the patients' abilities and preferences, and setting measurable and attainable goals, were important for success. Moreover, involving qualified professionals (e.g. exercise professionals and dietitians with expertise in mental healthcare) and ensuring cooperation between patients and healthcare professionals and disciplines within and outside mental healthcare appeared crucial.br/CONCLUSION: Successful implementation of lifestyle interventions in mental healthcare requires changes in culture and behaviour, a long-term strategy and endurance.

Background A more preventive and proactive approach in youth mental health care can contribute to reduce the severity of psychological problems in young people and help to reduce the risk on treatment resistance. Aim To show opportunities to organize youth mental health care more proactively. Method Discuss new approaches based on existing literature and examples from clinical practice. Results It is essential that young people receive treatment that is appropriate for the severity of their problems. Early detection and prevention can be systematically carried out in collaboration with public health service and schools. In addition, it is imperative that young people receive appropriate (specialized) mental health care based on their prognosis. Conclusion Committing to the right care at the right time is essential to prevent the development of co-morbidities, stagnation in development tasks and therapy resistance. Tijdschrift voor psychiatrie 63(2021)2, 111-114.

Quality systems have become an important and widely used method of monitoring and improving the quality of care in mental health care. However, little is known about the impact of these systems on the daily practice of care.br/AIM: To determine and explain the impact of quality systems.br/METHOD: A combination of qualitative (focus groups, document analysis, interviews) and quantitative (questionnaire, literature analysis) data collection and analyses based on different theoretical perspectives.br/RESULTS: There are many quality systems available, while the impact on the practice of care is limited. Many systems are unknown and are not used or used inadequately. The lack of impact can be explained by role uncertainty and mistrust in the sector. The fact that certain systems are used can largely be explained by the individual preferences of professionals.br/CONCLUSION: The current deployment of quality systems is very inefficient. There is no common definition of quality and the quality information from the systems is complex. This complicates the application of quality information. In addition, there is a great deal of mistrust towards the sector, which means that systems are used for control rather than for quality improvement.

In this commentary, the current directives and supporting methods to assess suicidal behaviour are briefly introduced and their shortcoming in predicting the risk of suicide is acknowledged. The treatment of a patient with suicidal behaviour by a general practitioner (GP), based on an already existing relationship between the two, is questioned. Instead, a close collaboration between GP and emergency mental healthcare providers is recommended. This working relationship should be maintained by both parties. Suicide after an intervention can have a major impact on the professionals involved. Therefore, these cases deserve specialised attention to ensure sustainable commitment of healthcare professionals confronted with complex mental health cases.

Previous studies found that the implementation of service guideline recommendations can significantly reduce the number of suicides in mental healthcare. Important barriers to suicide prevention guideline implementation are a lack of professionals' knowledge and competence towards the suicide prevention guideline.br/AIM: To assess professionals' knowledge of, competence in, and adherence to the suicide prevention guideline in twelve Dutch specialist mental healthcare institutions.br/METHOD: In this study, professionals working at crisis teams and outpatient care teams from each of the 12 participating mental healthcare institutions in the network of supranet Care were invited to fill in a questionnaire examining professionals' knowledge of, competence in, and adherence to the suicide prevention guideline (N = 400). Results were analyzed with multilevel regression analysis and adjusted for confounding.br/RESULTS: Although professionals scored high on knowledge, competence, and adherence towards the guideline, they did not know to what extent the guideline was implemented within their own team. Outpatient care teams scored significantly lower on professionals' knowledge and reported lower levels of competence. Furthermore, we found significantly higher scores on adherence to the guideline for professionals in crisis teams compared to outpatient care teams. Healthcare professionals also reported practice variation within and across Dutch mental healthcare institutions. CONCLUSIONS Practice variation within and across teams and mental healthcare institutions is undesirable. To reduce this variation, professionals and mental healthcare institutions should share best-practices and learn from each other how the quality of care for suicidal patients can be optimized.

Older patients with combined psychiatric, physical and cognitive health problems - patients who need double care - benefit from integrated medical and psychiatric care. The characteristics of these patients, as well as the problems that may exist in offering them adequate integrated care, are illustrated on the basis of a case description. Improvement of existing regional arrangements, premised on a collaborative care model, and involving hospital care, mental health services, nursing home care and community care services, is recommended. In settings that offer 24 hour long-term residential care and treatment, the expertise of mental health services and nursing homes must be structurally combined.

Compulsory treatment in mental health care has continuously increased for years. Registration of court ordered compulsory psychiatric care is based upon counts of legal authorisations. These counts do not refer to number of individual persons involved.br/AIM: To report the number age-specific prevalence of coercion in psychiatric care, number of persons involved, age distribution and regional differences.br/METHOD: Analysis of the number of requests for compulsory care and population size according to the age groups for the years 2013-2017. We used direct age standardisation at the level of jurisdiction regions.br/RESULTS: The annual number of unique persons for whom compulsory care was requested was 28% less than the number of requested court orders. The annual increase in compulsory care was 3%. Per specific treatment order the increase during 2013-2017 was 12% for emergency compulsory admissions, 8% for hospital admissions, 10% for extended hospital admissions and 43% for community treatment order.br/CONCLUSION: The number of persons for whom compulsory mental care is requested increased on average by 3% each year. Greatest increase was observed for age groups 25-44 years and 80 years and older. After age-standardisation substantial differences remain between jurisdiction regions.

Thanks to the development in recent decades of mobile teams in the Netherlands and Belgium, ambulatory approaches have been created to offer effective treatment to patients with a first psychotic episode. If the support-network can no longer provide care, the person in crisis is referred to a hospital. The break with normal life and the associated stigma are often experienced as very radical by the patient himself, but also by his family.br/AIM: To explore the extent to which a Soteria House can have a place in current care for patients with an acute psychotic episode.br/METHOD: Description of the method of a Soteria House and reflection on the basis of the literature.br/RESULTS: A Soteria House offers a low threshold setting for people in a psychotic crisis, thanks to a destigmatizing approach. However, so far there is no scientific evidence of its effectiveness. In any case, the Soteria approach leads to greater satisfaction among patients and their family members.br/CONCLUSION: A Soteria House can offer a meaningful alternative to the hospital for the relief of an acute psychotic crisis. Also, from the Soteria model a number of elements can be included that benefit both out- and inpatient treatment of a psychotic episode. However, this model requires more thorough research before implementation in regular care is possible.

In the action plan 'Crossing the bridge' it has been proposed to realize a third less severe mental illness (SMI). To this end, in addition to the provision of recovery oriented care to people belonging to the SMI group, patients' problems should be prevented from becoming chronic.br/AIM: To conduct research into which mechanisms, according to Dutch experts, contribute to stagnated recovery processes and how chronicity can be prevented.br/METHOD: In a field consultation, 34 experts from different subsectors of mental health care were interviewed.br/RESULTS: The experts identified many factors that could stagnate the recovery of mental illness. The improvement proposals differed widely, but there was consensus on some key principles for the prevention of chronicity. For example, everyone agreed that practitioners should find a balance between providing good care and maintaining patients' own resources, encouraging patients' strengths, involving their social network in treatment, and helping to prevent loss of work, study and relationships.br/CONCLUSION: Many mental healthcare patients must receive integral care in an early stage in order to prevent far-reaching dependence on integrated care in a later stage. This requires that we involve family members and cooperate across sectors.

The benchmark methods of routine outcome monitoring (ROM)-data by the Dutch Mental Health Care Benchmark Foundation (SBG) have not been evaluated in independent research. No benchmark studies concerning private practices have been published. The Alliance of Quality in Mental Health Care (AkwaGGZ) has taken over the development of ROM; an excellent opportunity for improvement.br/AIM: To replicate (parts of) the SBG studies in a solo private practice.br/METHOD: Observational research on repeated measures with the SCL-90.br/RESULTS: During more than 12 years nearly 1,200 SCL-90 questionnaires have been completed by 644 patients. The ROM-group (≥2 measures, n = 339) and non-ROM-group (n = 280) differed in patient and treatment characteristics, but no differences in pre-test were found. In the ROM-group 73% reliable improvement was found and 45% clinically recovered. For the purpose of benchmarking, the ROM-cohort was divided in three subgroups, representing three so-called providers. Benchmark with these providers revealed differences in progress and results. Post-test was predicted by pre-test, co-morbidity, low and medium education, which explained 33% of the variance. Adjustment for these variables increased the discrepancies between providers.br/CONCLUSION: Applying ROM in clinical practice is, at patient level, a useful tool to manage treatment process and determine its termination. Within-therapist-benchmark of aggregated measurements is helpful in detecting patterns and pitfalls. The SBG studies contain methodological imperfections. Risk variables cannot be generalized over samples and risk adjustment should be avoided.

Recognition of intellectual abilities of a patient is essential for good treatment. However, this may be hard to achieve, even by experienced professionals.br/AIM: To educate professionals how to detect and diagnose intellectual impairment accompanied by an approximate knowledge on methods and pitfalls in establishing psychiatric diagnoses.br/METHOD: Several valid instruments for the screening of intellectual impairment in the Netherlands are described in conjunction with adjoining steps in the diagnostic process.br/RESULTS: To determine mild intellectual disability or borderline intellectual functioning by screening and testing intelligence and adaptive functioning, and by establishing an integrative diagnosis by including emotional as well as social level of functioning. Some pitfalls in the diagnostic process are discussed.br/CONCLUSION: Clinicians must be aware which tools to use to determine broad functioning of the patient and which further steps are necessary for a good diagnosis.

Despite the increasing attention for people with a (borderline) intellectual disability within the field of mental health care in The Netherlands and Flanders, access to mental health care for this vulnerable group is still limited.br/AIM: To explore the access to mental health care in the Netherlands and Flanders for people with borderline intellectual functioning or an intellectual disability.br/METHOD: A survey of scientific literature, recent reports and available practical knowledge about mental disorders in people with borderline intellectual functioning or an intellectual disability and their access to mental health care.br/RESULTS: Insufficient knowledge about mental disorders in long term intellectual disability care and insufficient knowledge of, and experience with borderline intellectual functioning and intellectual disability among mental health care providers play a role in the limited access to good mental health care. More exchange of knowledge and sharing of experiences is necessary to ultimately properly address the needs of this group.br/CONCLUSION: Structural collaboration between mental health care and care for people with an intellectual disability is needed.

Acute presentaties van psychiatrische aandoeningen vragen zowel binnen als buiten het ziekenhuis om efficiënte en zorgvuldige diagnostiek en behandeling. Vanwege de hectiek van het acute moment, waarbij vaak agitatie, suïcidaliteit, communicatieve uitdagingen en juridische aspecten een rol spelen, kan het inde praktijk lastig zijn om optimale en adequate zorg te bieden. Aan de hand van drie casussen geven wij handreikingen voor de diagnostiek en behandeling in dit soort acute situaties.A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.

Acute presentaties van psychiatrische aandoeningen vragen zowel binnen als buiten het ziekenhuis om efficiënte en zorgvuldige diagnostiek en behandeling. Vanwege de hectiek van het acute moment, waarbij vaak agitatie, suïcidaliteit, communicatieve uitdagingen en juridische aspecten een rol spelen, kan het inde praktijk lastig zijn om optimale en adequate zorg te bieden. Aan de hand van drie casussen geven wij handreikingen voor de diagnostiek en behandeling in dit soort acute situaties.A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' (www.acutepsychiatrie.com) can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.

Part of the quality of a mental health service is the degree in which the service can demonstrate that its output is aligned with indicators of population need.br/AIM: To investigate to what degree small areas in the Netherlands (PC3-level, 798 areas) differ in the level of mental health care consumption; to what degree this is reducible to demographic and socioeconomic indicators representing known predictors of population mental health needs; and to what degree associations between indicators of need and mental health consumption vary across regions.br/METHOD: Analysis of public mental health cost data in the Netherlands over de period 2011-2017 for the age group 18-65 years.br/RESULTS: Mental health care costs displayed a pattern of small area variation that for 77% was reducible to socioeconomic and demographic factors at the regional level. Mental health care costs were associated independently with younger age, female sex and a range of socioeconomic factors including urbanicity, ethnic density and a socioeconomic index variable. However, the degree to which these indicators of mental health needs impacted mental health costs varied from region to region.br/CONCLUSION: Regional mental health care output in the Netherlands is partially aligned with population needs These analyses validate the notion that mental health care commissioning may be guided by benchmarked evidence of service output being proportional to the needs predicted by population socioeconomic indices.

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Dutch policy aims to strengthen mental health care in general practices, to keep health care affordable. Recently, a new function (mental health nurses) and a new referral model for patients with mental health problems were introduced.br/AIM: To explore to what extent the volume of mental health care in Dutch general practices has increased and to what extent the content changed in the period 2010-2015.br/METHOD: This study employed: 1. analyses of medical records, and 2. a case study in a primary health care centre.br/RESULTS: The number of general practices with at least one mental health nurse increased from 20% in 2010 to almost 90% in 2015. In the period 2010-2014, general practitioners (gps) and mental health nurses treated increasing numbers of patients with mental health problems. No task shifting from gps to mental health nurses was observed. In the period 2011-2015, the number of antidepressant prescriptions increased slightly. In 2014, gps in a well-prepared primary care centre allocated 87% of their patients with mental health problems to a treatment setting in line with the referral model.br/CONCLUSION: Dutch general practices have recently provided more mental health care, thereby emphasising their important role in the mental health care system.

background The ability to predict the level of care (care burden) on the basis of patient characteristics is important for both the indication for treatment and the funding of mental healthcare. Within the framework of an administrative agreement in mental healthcare, a care demand intensity model 1.0 was developed. However, since the predictive power of this model is rather limited it remains controversial. aim To ascertain whether prediction of the level of care using the care demand intensity model can be improved by using more and more precise patient characteristics. method Comparison between the care burden estimate based on patient characteristics at intake into an addiction care institute and the care burden estimate determined by the indicators in the care demand intensity model. results Taking into account both the increasing number and more precise patient characteristics at intake in addiction care explained a considerably larger proportion of the variance in care consumption than the care demand intensity model 1.0.br/CONCLUSION: The estimate of the consumption of care can be greatly improved but remains an insufficient tool upon which to base funding.

ispartof: Tijdschr Psychiatr vol:61 issue:7 pages:436-438 ispartof: location:Netherlands status: published

A disorder-focused approach in mental healthcare in the Netherlands, combined with a disorder-linked reimbursement system, risks medicalisation of stress-related mental variations that may result from the current societal pressures to be beautiful and successful. Furthermore, a disorder-linked reimbursement system may lead to inappropriate treatment, dictated by group-based guidelines tied to DSM-classifications rather than the complexities and contexts of individual needs for care. Finally, there can be both over- and under-treatment as a result of a free-market healthcare system in which quality of care is equated with symptom reduction. We propose several adaptations, including, firstly, creating eCommunities offering self-help and peer support and, secondly, reinventing mental illnesses as vulnerabilities primarily requiring a 'heal and deal' approach of strengthening resilience as well as reducing symptoms. The conceptual foundation of mental healthcare as a free-market economy, and the current quality system, should be reconsidered. It is fundamental that reimbursement should not depend on arbitrary diagnostic algorithms of disorder.

Background A more preventive and proactive approach in youth mental health care can contribute to reduce the severity of psychological problems in young people and help to reduce the risk on treatment resistance. Aim To show opportunities to organize youth mental health care more proactively. Method Discuss new approaches based on existing literature and examples from clinical practice. Results It is essential that young people receive treatment that is appropriate for the severity of their problems. Early detection and prevention can be systematically carried out in collaboration with public health service and schools. In addition, it is imperative that young people receive appropriate (specialized) mental health care based on their prognosis. Conclusion Committing to the right care at the right time is essential to prevent the development of co-morbidities, stagnation in development tasks and therapy resistance. Tijdschrift voor psychiatrie 63(2021)2, 111-114.