Samen werken aan een beter leven!

CCITP conference on crisis, coersion and intensive treatment in psychiatry, october 18 / 2018, Rotterdam

J.H.Y. Traas MBA, manager division crisis mental health services Dimence & former mental health nurse specialist

Overview of the developments in finance and organization of the Dutch crisis mental health services

Programme

• Welcome

• Introduction symposium ‘You’ll get better at home’

• J. Traas: Overview of the developments in finance and organization of the Dutch crisis mental health services (25 minutes)

• E. Prinsen: Intensive Home Treatment in the Netherlands (25 minutes)

• G. Ruijgrok: General use of theoretical models of family therapy in the organisation of emergency psychiatry (25 minutes)

• 15 minutes for questions / debate

Overview of the developments in finance and organization of the Dutch crisis mental health services

• Introduction to the Netherlands

• Introduction Dimence

• Important developments crisis mental health services

• Shift from clinical (hospital) treatment to outpatient (community) treatment

• Intensive Home Treatment / High & Intensive Care-units

• New guidelines for crisis mental health services

• Pressure on local governments to arrange an effective chain for ‘disturbed persons’

Introduction to The Netherlands (17,1 million inhabitants)

A good place

for children to

grow up…

Source: UNICEF Office of Research, 2013

… and we are also a good place to grow old

Source: World Aging Index, 2015

6% of total health budget to mental healthcare

Total health budget =

€ 90 billion

6% mental health =

€ 7 billion

50%

7%9%

14%

20%Health Insurance Act

Long Term Inpatient CareActForensic Care

Youth Act

Social Support Act

Funding through 5 different sources of finance for mental health care

Source: Ministry of Health, State Budget 2015

Health Insurance Act € 3.592Long Term Inpatient Care Act € 0.523 Department of Security & Justice € 0.631Youth Act € 1.006Social Support Act € 1.433Total € 7.85 billion

Crisis services

Dimence, general figures

Over 60 locations

Main locations: Zwolle, Almelo, Deventer

1,2 million inhabitants.

14.500 patients annually

1.420 staff members

1.150 FTE

Budget € 123 million

Peildatum december 2017

How are we organized & specialized?

Outpatient mental health care: Specialised teams by diagnosis

Longterm mental health care:Personal & social recovery and treatment (FACT)

Mental health care for the elderly:Comorbidity mental & fysical problems

Acute mental health care:Preventing admission (IHT + HIC)

Topclinical mental health care:Highly specialized treatments

Man

agin

g b

oar

d

Crisis-services

• Netherlands have 28 crisis-services-regions

• Crisis resolution & Intensive Home treatment

Dimence• 3 IHT-teams (24x7) crisis services• Within 2 hours an assesment by a nurse

and a psychiatrist (preferable at patient’shome)

• 3 High- & Intensive care units (37 beds)• 3 Medium care units (31 beds)

There has been a shift from clinical and specialist mental healthcare…

…to outpatient and primary mental healthcare…

Shift in recent years

From clinical and specialist mental healthcare to outpatient and

primary mental healthcare.

Resulting in a

more complex

playing field

for the patient

Patient

Insurers

Mental health care

Municipalities

Housing

Employee Insurance Agency

Education

General practitioner

Neighbourhood social work teams Public prosecution servicePolice, etc.

Current position in shift to outpatienttreatment..

48.0

50.0

52.0

54.0

56.0

58.0

60.0

62.0

64.0

66.0

2014 2015 2016 2017 2018

Begroting ambulant 2014-2018 (x 1 mln)

450

470

490

510

530

550

570

590

610

630

650

2014 2015 2016 2017 2018

Aantal bedden Dimence 2014 - 2018

Indoor - 13%

Out-patient+ 19%

Number of beds 2014 - 2018

Budget outpatient treatment 2014 – 2018 (x 1 mln)

Outpatient crisis care

• The number of in-patient beds for

psychiatric treatment in the

Netherlands in high

• Assertive outreach (FACT) resulted in

a decline of long-term admissions.

• Acute psychiatric admissions can

also be prevented (or at least

shortened) by using intensive home

treatment.

Inpatient crisis care

• Medium care (semi-open)

• High- & Intensive care

• Focus on engagement

• Reducing coersion

• Stay connected

• Healing environment

Chances & challenges for crisis services

• Implementing a new nationale standard for crisis mental

healthcare• Organising a psychiatric assessment within 1 hour in case of high urgency situations• Outdoor assessments always with 2 professionals (nurse & physician)• 24x7 psychiatric triage personell available on telephone in between applicant and outreach-team

• Connecting public domain to professional mental healthcare

domain

• Position national police: no more transport of patients

• Labourmarket

Samen werken aan een beter leven!

We believe in working together for a better life

Do you?