No Place for Big Problems
Tackling specialist mental healthcare waiting lists
The Netherlands Court of Audit has investigated the approach to tackling waiting lists for specialist mental healthcare. The approach is so diffuse that patients with severe psychological problems, often caused by multiple disorders, are unable to receive care. An estimated 11,000 of these patients have to wait 4 months or longer before their treatment can begin.
The more complex the problem, the longer the waiting list
The Court of Audit concludes that the more complex a problem is, the longer the waiting list. This is particularly true if a serious psychological problem is complicated by other problems or if the patient is also mentally impaired.
The estimate that 11,000 people have to wait too long to be treated is based on samples of the waiting lists for mental healthcare kept by the sector associations GGZ Nederland and MeerGGZ in 2018. The figure is about 40 times higher than the 250 to 300 patients that the State Secretary for Health, Welfare and Sport (VWS) recognises in the action plan he sent to the House of Representatives in March 2020. The Court of Audit therefore believes there is a risk that the plan ‘will inadequately contribute to reducing waiting lists’.
Most of the 1.3 million people who receive mental healthcare every year are helped promptly. However, for the relatively small group of some 11,000 people the consequences of long waiting lists can be serious.
The Court of Audit identified 3 causes of the long waiting lists:
- Financial incentives make it more attractive for care providers to concentrate on patients with milder problems.
- Patients with severe care needs are referred to multidisciplinary mental healthcare institutions. Such integrated institutions suffer from capacity problems, including staff shortages.
- It is difficult to arrange suitable aftercare for patients who are discharged. As a result, they occupy beds that should be released for new patients.
What are our recommendations?
The Court of Audit recommends that the State Secretary for VWS introduce a waiting list policy specifically for the group of 11,000 patients that currently have to wait 4 months or longer to be treated.
What methods did we use to investigate specialist mental healthcare waiting lists?
To investigate the approach to specialist mental healthcare waiting lists, we studied relevant literature, analysed data and held 50 interviews with stakeholders, including representatives of national organisations, mental healthcare providers, patient representatives, general practitioners, care insurers, municipalities and stakeholders in 8 regions (taskforces are actively tackling waiting lists in 6 of these regions).