Creating Barriers to Mental Health Care in the Netherlands
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.
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