Community care arrangements in the Netherlands

In several developed countries, the objective is a mental health system dominated by variants of community care arrangements as replacements for hospital. This is also true on the Netherlands. In recent years, several intensive casemanagement projects have been started for chronic psychiatric patients. This article looks at four well-known Dutch projects. All the patients in the four projects are very ill and most of them suffer from schizophrenia. The influence of the new forms of care on everyday problems is slightly positive. The new forms of care are feasible for most chronic patients. On the basis of the data, it cannot be said whether the risk of suicide increases, remains constant or even decreases. In three of the four projects there is a drop in compulsory admissions. In two of the four projects there is a spectacular decrease in number of bed days. In the third project, there is a sharp reduction in the number of bed days when the group is compared with a matched group. No figure could be obtained for the fourth project. The initial impressions are quite positive. But research remains vital, in particular randomised clinical trials which assign a high priority to the specification of target groups and of interventions and which focus more on the relationship between costs and benefits