Mental health care in

the Netherlands
And the new role of the peer
specialist
 The system of the mental health care and the
experiences with the role and the employment
of the peer consultants in the Netherlands
 History
 Recovery Movement.
 Recovery oriented care
 Peer specialist
Recent history (till 90’s)
 After 6 months point of
no return

 Staff in role of guard

 Doctor knows best
 No perpective
 Hospitalisation
 Loss of roles and
competence
Goffman 1957
Closing MH institutions??
WHO
New Asylums??
Same message
 We are changing our ideas

Old Belief was {Disability, being a victim,

↓ looking for someone to
take care/fix me

Empowerment {To produce the results I want

↓

Enlightenment {Ability; discovering my gifts and

strengths
 Recovery (Anthony 1993)
" a deeply personal, unique process of changing
one’s attitudes, values, feelings, goals, skills
and/or roles. It is a way of living a satisfying,
hopeful, and contributing life even with
limitations caused by the illness. Recovery
involves the development of new meaning and
purpose in one’s life as one grows beyond the
catastrophic effects of mental illness."
Research
 Aspects of Recovery(Droes, 2010)
Process Result

Recovery of Assertiveness Less symptoms

illness Treatment Cure
Illness management

Recovery of Rehabilitation Inclusion

roles Stigma productive member
of society
Recovery of Recovery story Personal identity
identity Empowerment Wellness
Lived experience
herstel
 Rec Oriented Practice (le Boutillier, e.a. 2011)

 Supporting personally defined recovery.

 Promoting Citizenship

 Commitment of organisation

 Working relationship.
Reducing number of
long stay beds
What did we learn?
 ACT History
 Deinstitutionalisation
 Revolving door group (1 / 3)
 Wisconsin Training in community Living (TCL)
(Test and Stein 1976)

 TCL  Assertive Community Treatment

(ACT)

19 FACT NHN
 What is ACT?
An evidence-based practice (EBP) for adults with severe
and persistent mental illness
A team-based approach to providing treatment,
rehabilitation, and support within the community
Focus on working collaboratively with consumers to
address full range of needs in the community:
 Obtaining housing  Improving skills
 Securing benefits  Working with families
 Engaging community  Gaining employment

20
 ‘Netherlands
 ACT (since 2003)
 Flexible ACT (since 2006)
 Early Intervention Psychosis
 Forensic ACT

 Total round 160

21 FACT NHN
Flexible ACT in the
Netherlands
FACT Teams in the heart of the
organisation for SMI
 Flexible ACT

 Instead of ACT and step down teams  FACT

 Cure and care for persons with a SMI in MH
organisation is offered in FACT teams.
 Focus on social inclusion & recovery
 Increasing continuity of care and a flexible
response
 FACT
 Flexible ACT team offers care and treatment to all SMI-
population in a catchment area:
 50.000 inhabitants  ± 200 persons with SMI

 FACT teams are working with TWO procedures;

 Lower scale: state of the art treatment (casemanagement within a
multidisciplinary team)

 High scale: Full ACT with teamapproach by the same

multidisciplinary team
 Procedure for up- and downgrading of care within the same
team
 Six Principles
1. We’ll be there
where the client
wants to be
successful!
.
2. Support for 3.Binding in the
community MHC network.
participation
Continuity of care
Fam / CSS / Stigma between Hospital and
community / 7 x 24
6. Focus on
4. ACT 5.Treatment recovery
Flexible available
when necessary EBM & Guideliness. Peer support, WRAP,
IPS
Proces
 Rich Multidisciplinary team

 Team (+/- 11 FTE) for 160 – 180 patients:

 (community) psychiatric nurses
 Psychiatrist
 Psychologist
 Peer specialist,
 Social worker,
 Substance Abuse (IDDT)
 Supported employment specialist (IPS)
 Manager / team leader
 Since introduction ACT FACT
 Peer specialists in teams:
 Mainly in ACT and FACT teams, Acute wards,
Sheltered housing
 Recovery coaches

 Recovery trainers, WRAP facilitators

 Advisors

 Stigma buster
 GGZ NHN
 2004 Start FACT teams
 2006 First Peer support worker
 Now 26 most in FACT teams
 Acute wards
 Elderly

 Autism

 Long stay

 Activity centre
 GGZ-NHN

 12 FACT teams
 600.000 inhabitants
 2500 SMI in FACT
 SMI case definition
 A severe psychiatric disorder in need of
treatment (not in symptomatic remission)
 Severe limitations in social functioning (= not
in functional remission)
 Psychiatric disorder <-> limitation
 Long term condition
 Indication for co-oordinated network of
professionals

Delespaul
ACT in Netherlands
 (Mental) Health Policy
 Insurance companies represent choice for
consumers
 Slow start of reduction of beds Long stay and
Acute
 Way: FACT and IHT
 Futhermore more MH in ‘first line’
Certification and model
fidelity of ACT and FACT
in The Netherlands