Since 2019, ahti has been working with the City of Amsterdam, VU Amsterdam (VU) and Erasmus University Rotterdam to provide insight into the pathways between the various components of the mental healthcare system in Amsterdam. When the Dutch healthcare system was reformed in 2015, the City of Amsterdam became responsible for sheltered housing under the Social Support Act (‘Wmo’). More and more people are making use of such housing, but there has been no decline in the cost of day care provided by the City’s Social Support Department. As a result, the City has a double cost burden. In this study, we are trying to find out whether people are receiving appropriate amounts of care. Ahti is combining multiple data files with information about individuals within a secure Statistics Netherlands environment. We are visualising the results in graphics to give insight into care service use and care pathways. We will make the results available to a wide audience.

Are people receiving appropriate mental healthcare since the reform of the Dutch healthcare system?

Various forms of care are available to people with psychological disorders, from in-patient intensive care to minor ambulant assistance. The City of Amsterdam aims to provide adequate care; not too little, but also not too much. Roughly 50,000 Amsterdam citizens make use of the city’s mental healthcare services.

In 2018, 1387 sheltered housing establishments were in use, compared with 832 in 2017. However, there has been no decrease in the use of 24-hour beds available by the City’s Social Support Department for those who cannot live independently. The City therefore has a double cost burden, although the objective is to get people living independently more quickly and reduce pressure on the budget. The City is consequently keen to gain insight into mental healthcare pathways in order to better align policy with them.

In this project we distinguish between various forms of mental healthcare:
1. Specialist intramural mental healthcare
2. Sheltered housing
3. Ambulant care
4. Passive ambulant care

Gaining insight into and promoting cooperation between mental health service providers in Amsterdam

The project’s first phase involves researching what kinds of patient (diagnosis, demographic characteristics, socio-economic characteristics) make use of what kinds of care. We are also looking at patient transitions between the four forms of care. Thus, we wish to investigate whether people are receiving appropriate care, and the right amount of care (neither too much nor too little).

The project’s second phase involves comparing the use of care services between 2014 and 2015 (before and after the system reform), when the City of Amsterdam suddenly became responsible for providing sheltered housing. We are investigating whether patterns in care service use and/or the composition of patient populations have changed.

Thus, we hope to determine whether Amsterdam citizens are receiving adequate and appropriate mental healthcare. In 2015, the Dutch healthcare system was reformed and responsibility for the provision of some healthcare services was transferred from the central government to the municipalities under the Social Support Act (‘Wmo’) and other legislation. We are therefore comparing figures from 2014 (before the system reform) with healthcare data from 2015-2016 to find out what happened to mental health patients after the introduction of the Social Support Act. We are looking at patterns of specialist mental healthcare use, individual-level logistic regression, and patient transitions between different forms of care.

Status of the Tailored Mental Healthcare project

The analysis is as good as finished and we will be presenting the results to the City of Amsterdam shortly.

The results of the analysis will give the relevant parties insight into:

• What kinds of people (with what demographic characteristics) make use of the Social Support Act sheltered housing provisions
• How the influx and outflux of patients changed after the reform of the Dutch healthcare system

The City will use these analyses to inform further policy development.

Partners

• City of Amsterdam
• Erasmus University Rotterdam

Contact

Want more information or do you have a question? Please contact Rosan van Zoest.