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Transcript of Overview of the developments in finance and organization ... · Samen werken aan een beter leven!...
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
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)
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