‘The way that depression is treated in the current healthcare system is a waste of money’, according to clinical psychologist Claudi Bockting. The current funding system means that clients only receive truncated treatment programmes. The inevitable result is a relapse into depression. ‘Investments are only made with an eye to the here and now, without taking the long term into account. As a result society is wasting millions of euros.’
In the Netherlands, depression generates more than EUR 660 million in care costs every year. No fewer than one in four women and one in eight men are confronted at some point with depression. Leaving aside the human suffering involved, this leads to absenteeism, loss of work hours and high healthcare costs. Depression thus generates a further EUR 950 million in lost production.
When treating depression, it is very important to ensure that people not only get better, but stay better. ‘We’ve known for about twenty years that many people suffer depression relapses. The longer the treatment, the less of a risk there is of a relapse. Eventually you reach the point in the recovery process where someone no longer has symptoms. There are also short-term treatments available that protect against a relapse after recovery.
However, health specialists are usually not given the opportunity to continue the treatment. ‘Waiting lists and market forces in health care put pressure on mental healthcare institutions and specialists to round the treatments off quickly. They just don’t care about the long term’, comments Bockting – or about aftercare, resulting in patients often returning after a relapse.
Since the introduction of the Diagnosis Treatment Combination (DBC – Diagnose Behandel Combinatie), funding for care has also changed. Care providers are now only paid once the treatment has been rounded off. Bockting: ‘This stimulates specialists to end the treatment early.’ This also applies to independent therapists: ‘This type of funding hits them right in their wallets.’
The result is not only social costs, it does not do any credit to the scientific developments that have been made either. ‘The risk of a relapse is significantly reduced by starting specific, short-term psychological intervention methods after recovery. Although these treatments save money in the long run, they are hardly ever applied’, notes Bockting.
Mental healthcare institutions (GGZ) are already at their wits’ end trying to provide sufficient care to all the people who apply to them. ‘There is enormous pressure to work people through the system as quickly as possible so as to try to get through the waiting lists. There’s certainly the will there to offer treatment that not only cures patients but keeps them cured, but the current funding system does not encourage that choice. The treatment usually stops once the patient has been patched up.’
Bockting also works for a GGZ institution. ‘This problem cannot be solved by the directors of GGZ institutions or treatment providers alone. There’s plenty of goodwill, but they have limited capacity and have to choose the lesser of two evils – either make new patients, often with serious psychological problems, wait longer, or offer patients care that only patches them up. The current funding system does not encourage them to do anything more.’ Bockting is in favour of separate budgets for psychological interventions after recovery. ‘That way you make sure that someone not only gets better, but stays better.’ She also thinks it is important to develop a vision regarding the funding of chronic psychological disorders. ‘We should ask ourselves whether the current “piecework” system is the best one for chronic, recurring disorders.’
Dr Claudi Bockting (1969, Silvolde) studied psychology at the University of Amsterdam. Bockting is an associate professor in clinical psychology at the University of Groningen. Her research concentrates on psychological intervention methods for chronic and recurring disorders, including interventions that reduce the chances of depression relapses (see www.doorbreek-depressie.nl). She also works as a clinical psychologist for Symfora.
For further information: Claudi Bockting
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