These are tough times for the GGZ, says Delespaul. While less money is available, the number of people with a mental illness is by no means shrinking. With capacity far outweighed by demand, the GGZ faces some difficult choices.
In these times of austerity, therefore, Delespaul believes that the GGZ cannot just point the finger at the government and everything it is doing wrong. Instead, concrete proposals and solutions are needed. “In mental healthcare, just as in any other area, budget cuts are inevitable and we have to develop alternative ways to provide good care with less money”, he says. Anything to ensure that psychiatry does not go down its former path as described by Michel Foucault in 1972: managing the ‘lunatic’ through social exclusion.
“That’s something we must avoid at all costs”, says Delespaul. “Psychological problems are very common. One person in every four suffers from a psychological problem each year. At the same time, the quality of the care provided has been called into question and the costs are growing. And when psychiatry makes it into the news, it doesn’t come across as overly credible. This impasse has come about through government measures in recent years. In a market that has to cater for potentially 25% of the population, we have the capacity to provide care for just 6%. There are just not enough care providers or budgets to pay them.”
Netherlands leads in number of psychiatric beds
One strategy to help more people with less money, according to Delespaul, is to reduce clinical admissions while still providing the same quality of care. This would enable providers to offer care to more people with psychological problems. “I have no doubt that this could be a good solution. Especially when you consider that the Dutch are the European leaders when it comes to the number of patients we admit to clinics. We have to be much more critical about the solution offered by clinical admission. The trend these days is towards outpatient care, even for people with severe mental disorders who have great difficulty functioning in society at large. In the Netherlands alone this group consists of more than 200,000 patients. Keeping in mind that there are only 25,000 to 30,000 beds, it adds up quickly. There just isn’t room for most people with severe mental disorders, and the number we do admit will have to be reduced even further.”
In Delespaul’s view, the care system should draw more links between the psychopathology of patients with severe mental disorders and the social system of which they are part. An example of this is Flexible Assertive Community Treatment (FACT), a form of GGZ care provision in which Delespaul is closely involved: “It’s a great way to reduce hospital admissions and help more people.”
The idea behind FACT is that multidisciplinary teams actively approach people with severe psychiatric problems, visiting them in their own environment, providing them with coaching, and helping them with practical matters. There are now around 200 FACT teams in the Netherlands and this number is expected to reach 400 to 500 teams in the coming years. “Each team consists of 10 to 12 care providers and can help around 200 people, which adds up to 100,000 patients. The teams offer therapy and medication, but also help people to change the context in which they live, giving them greater stability and preventing them from ending up in a clinic. It’s a personal process, which in the best-case scenario offers genuine hope for recovery.”
This perspective, according to Delespaul, is a relatively recent development. “The GGZ is becoming persuaded that, over time, phase-based care is giving patients with severe mental disorders – who had long been written off as untreatable – better treatment and a better quality of life. That’s good to see.”
Philippe Delespaul(1958) studied at the University of Leuven (Belgium), specialising in clinical psychology, mathematical psychology and psychological methodologies and statistics. He is a supervisor for clinical psychologists and behavioural and cognitive therapists and leads the programme Integrated Care in South Limburg. In addition, he is a professor at the Department of Psychiatry and Psychology as well as the School for Mental Health and Neuroscience at the UM Faculty of Health, Medicine and Life Sciences. Delespaul has written more than 100 articles and chapters in peer-reviewed international publications and consults in national and international research networks.