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

illness

Assertiveness

Treatment

Illness management

Less symptoms

Cure

Recovery of

roles

Rehabilitation

Stigma

Inclusion

productive member

of society

Recovery of

identity

Recovery story

Empowerment

Lived experience

Personal identity

Wellness

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

2. Support for community participation

Fam / CSS / Stigma

1. We’ll be there where the client wants to be successful!

.

3.Binding in the MHC network. Continuity of care between Hospital and community / 7 x 24

4. ACT Flexible available when necessary

5.Treatment EBM & Guideliness.

6. Focus on recovery 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

Delespaul

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

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