The Health Care Insurance Board (CZV) wants to make drastic cuts in the reimbursements for treating psychological disorders as the current economic situation has increased the pressure to make cuts in the mental healthcare service. Claudi Bockting, Associate Professor in the Clinical Psychology Department of the University of Groningen, is fiercely contesting the recommendations made by the Health Care Insurance Board. ‘In a crisis, the economy needs people with psychological problems to be treated promptly and given help to prevent relapse. This view is gaining support within the international scientific community. By implementing the proposed cuts, the Netherlands would be bucking the international trend.’
According to Bockting, it is time for a fundamental discussion of ‘costs’ in the Dutch mental healthcare system. ‘Are they really costs, or are they investments? Although cutting the costs of mental healthcare via the insurance companies will probably reduce the short-term financial burden on healthcare insurers, the message I am trying to get across is that this will only lead to increased costs in other areas. We will see an increase in absenteeism and a drop in productivity, both of which are bad for employees, employers and the economy. In addition, these proposed measures will probably cause an overall rise in healthcare costs in the medium to long term. The measures form an obstacle to prompt intervention and will inevitably cause a rise in the number of people with chronic psychological problems.’
The chances of developing depression during an economic crisis are considerably higher than at other times. Redundancy, bankruptcy, debts and poverty are all factors that contribute to the development and continuation of depression. There are plenty of effective specialized methods for preventing depression, treating depressive disorders and fending off a recurrence of depression. Bockting: ‘In an economic crisis, good mental healthcare is vital to society. We shouldn’t be imposing cuts on people who are at risk of illness or a recurrence of their illness.’
There is growing international consensus about the social impact of depression. The World Health Organization WHO refers to ‘unipolar depression disorders’ as a major group of chronic illnesses that have a negative impact on society and the economy. Once they develop, chronic depressive disorders tend to recur. The World Economic Forum estimates that the global economy lost a staggering 2.5 trillion dollars in 2010 as a result of depression, and claims that this figure could rise to 6 trillion dollars by 2013.
The WHO also predicts that by this time, depression will have overtaken infectious respiratory diseases and diarrhoea in the chronic illness rankings. In view of this development, Bockting thinks that making cuts in mental healthcare would be a short-sighted move. ‘We’ve developed effective (and cost-effective) psychological treatment for depression, as well as highly effective interventions to ensure that depression does not recur. It is vital that we prevent recurrence, as this will not only reduce absenteeism and uphold productivity levels, but also help people at risk of becoming unemployed.’
Not by chance, last autumn the leading scientific journals The Lancet and Nature featured editorials stressing the economic and social importance of mental healthcare. Nature claims that there is no longer any doubt about the success of involving psychologists and refers to the lack of sufficient funding for research into improving these methods as scandalous. The Lancet concludes that governments should pay heed, saying: ‘Governments can certainly not afford to ignore the burden of mental disorders.’ Bockting draws attention to the fact that this message did not appear in a psychiatric magazine, but in a highly respected medical journal.
As yet, there has been no decision about the Dutch situation. The Health Care Insurance Board is considering the possibility of reducing costs in the Dutch mental healthcare service. Bockting has worked in the sector for more than twenty years and understands this reaction. ‘But I think society would be better served if we found ways to use the same resources to prevent people falling ill as far as possible. Our priority must be to ensure that people with psychological disorders are given the specialized care that has been proved to be effective.’
Bockting doubts whether the Dutch mental healthcare service is currently equipped to meet this target. ‘Mental healthcare organizations were forced to amalgamate, resulting in huge strongholds with numerous management levels. I seriously wonder whether this is the most efficient model.’ Bockting is arguing the case for consultation between stakeholders, including healthcare insurers, the relevant professional associations, universities and government, to explore ways of optimizing the Dutch mental healthcare service, preferably at no extra cost.
Claudi Bockting is Associate Professor in the Clinical Psychology Department of the University of Groningen. She is currently conducting follow-up research into the most cost-effective method of preventing a recurrence of depression. This research (among people who have recovered from depression) involves comparing preventive psychological training with the long-term use of antidepressants and with a combination of both interventions. Bockting also works as a clinical psychologist at a Dutch mental healthcare institution.
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