The changing structure of Dutch mental health care

Abstract

Current mental health care policy in The Netherlands emphasizes a major shift from intramural to extramural care. A decline in psychiatric hospital admissions is to result from (a) intensified psychiatric care offered by non-residential provider agencies, (b) an increase in sheltered housing and day care capacity and (c) an integral role in mental health care for the general practitioner. To allow for such a far reaching change, fortification of the greatly fragmented non-residential sector of Dutch mental health care was necessary (in 1982 more than 300 agencies in a country of 14.5 million inhabitants). Mergers have recently led to 60 Regional Institutes for Ambulatory Mental Health Care (RIAGG). This amalgamation within the non-residential sector is considered a major step towards the integration of the entire Dutch mental health care system. The article provides insight into the development of mental health care policy in The Netherlands and offers an analysis of the process of merger of non-residential services. As a necessary preface to this material a sketch of the historical and administrative context of Dutch health care is provided.mental health care restructuring policy development