Change in Dutch mental health care:an evaluation

Background: In the Netherlands there has been no distinct period of deinstitutionalization or transinstitutionalization of mental health care. Rather, the Dutch government expects local mental health services to reform their joint service provision without forceful measures like cutting budgets of large mental hospitals. This study aimed at quantifying gradual changes in the use of community- and hospital-based care. Methods: The Groningen psychiatric case register was used to determine the number of users and the amount of use of mental health services. Changes in population size and age distribution were accounted for by means of demographic data. Results: The number of users of innovative psychiatric treatment modalities more than tripled between 1989 and 1997. In the same period, the volume of traditional inpatient care gradually decreased. This was caused primarily by a reduction in the length of stay in the hospital. Conclusions: These findings seem to support the effectiveness of Dutch substitution policy. However, there is also a cause for concern. Though people use new mental health care provisions, there is a rapidly growing number of them who do so.