0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Creating Barriers to Mental Health Care in the Netherlands
Johannes E. Hovens, M.D., Ph.D.; G. Johannes van der Ploeg, M.D.
Psychiatric Services 2011; doi: 10.1176/appi.ps.62.9.1106
View Author and Article Information
The authors are affiliated with the Teaching Department, Delta Psychiatric Center, Poortugaal, Netherlands.
The authors are affiliated with the Teaching Department, Delta Psychiatric Center, Poortugaal, Netherlands.Dr. Hovens is also with Erasmus University, Department of Psychology, Rotterdam, Netherlands.

The authors are affiliated with the Teaching Department, Delta Psychiatric Center, Poortugaal, Netherlands.

Dr. Hovens is also with Erasmus University, Department of Psychology, Rotterdam, Netherlands.

Copyright © 2011 by the American Psychiatric Association.

To the Editor: The article in the July issue by Bruwer and colleagues (1) described attitudinal and structural barriers to mental health care and predictors of treatment dropout in South Africa. The study found that the most commonly cited reason for not seeking care was a low perceived need for treatment and that lack of health insurance was an important reason for treatment dropout. Similar results were found by Sareen and colleagues (2) in a study that compared the United States, Ontario, and the Netherlands. Remarkably, fear of stigmatization was not frequently cited as a reason for not seeking care in the studies. However, it should be noted that these studies did not include persons with more severe psychiatric disorders, such as psychosis.

Currently, the Dutch government is planning what might be called a cynical experiment—to levy a considerable patient copayment for the treatment of mental disorders. Patients who are unable to pay may request financial compensation from the local council; however, under the current austerity policy, the councils have undergone severe budget cuts.

It may be expected that structural barriers to care will increase in the Netherlands among persons with severe mental disorders, most of whom are on the verge of poverty and lack insight into their illness. Because only patients who are involuntarily admitted to the hospital are exempt from this copayment, such admissions can also be expected to increase.

Other aspects of this austerity policy are the exclusion of adjustment disorders from coverage for treatment and a limit of five treatment sessions for persons with mental disorders in primary care. Such policies imply that these patients are simply whining and not suffering from a mental disorder. At the same time, several groups in the Netherlands have initiated campaigns against stigmatization of mental disorders.

We understand that economizing cannot be avoided, but it is difficult to understand why patients with mental illness are regarded as separate from those with general medical conditions. Choosing which patients should receive treatment on the basis of their illness is nothing less than discrimination. For individuals who have some historical consciousness, it brings to mind the first steps in the annihilation of psychiatric patients in the 1930s because they were considered inferior.

Bruwer  B;  Sorsdahl  K;  Harrison  J  et al:  Barriers to mental health care and predictors of treatment dropout in the South African Stress and Health Study.  Psychiatric Services 62:774–781, 2011
[PubMed]
[CrossRef]
 
Sareen  J;  Jagdeo  A;  Cox  BJ  et al:  Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands.  Psychiatric Services 58:357–364, 2007
[PubMed]
[CrossRef]
 
References Container
+

References

Bruwer  B;  Sorsdahl  K;  Harrison  J  et al:  Barriers to mental health care and predictors of treatment dropout in the South African Stress and Health Study.  Psychiatric Services 62:774–781, 2011
[PubMed]
[CrossRef]
 
Sareen  J;  Jagdeo  A;  Cox  BJ  et al:  Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands.  Psychiatric Services 58:357–364, 2007
[PubMed]
[CrossRef]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 5.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 36.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
PubMed Articles