Miranda (her real name is known to the editors) has been severely depressed for years. She made several suicide attempts. After months of fighting waiting lists, she has been receiving intensive therapy at the Center for Psychotherapy at Pro Persona for ten weeks.
“I am now in my tenth week, my treatment lasts a total of 34 weeks. From Sunday evening to Thursday I am intern in Lunteren.”
Closure
Miranda’s therapy often consists of group sessions. It is intensive, but slowly she feels progress. The news of the closure hit like a bomb. “A board member told us that the institution intends to stop this treatment on 1 July.”
What does that do to her? “As if I’m being abandoned again. It causes a lot of unrest, we don’t know where we stand.”
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Very radical
A spokesperson for Pro Persona confirms the intended closure. “We have been dealing with a negative return for four years. This form of concern weighs too heavily on our budget.” He would not say how much the treatment will cost, but experts are thinking of several tens of thousands of euros per client. “It is all drastic, but we have to make choices and then we choose to stop this care so that we can continue to provide other therapies.”
The maintenance of the expensive buildings, located in the woods, also puts pressure on the budget, the spokesperson admits. There are 135 treatment places in Lunteren.
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duty of care
Healthcare institutions have a duty of care. This means that care for current clients must continue. “The clients who are in the middle of their trajectory can complete the treatment. We also plan to offer care in our own region in ambulatory form (day admissions, not internally) and to relocate the care as much as possible with other providers.”
After 1 July, care may be offered in a modified form. There will also be a withdrawal stop: new clients can no longer go.
It causes a lot of anxiety. Also with Miranda. “I don’t know how it will continue for me. I have built a relationship of trust with my group and therapists. But who says they will stay and what will change with my group? It will all change and you can feel the unrest every moment,” says they. Deadly for her treatment, she thinks.
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Politically, The Hague is also stirring. The closure of the mental health care institution in Lunteren is not an isolated incident. One institution after another is cutting mental health care and stopping treatments. In addition to Pro Persona, the Amsterdam institutions PsyQ and i-Psy (Parnassia Group) have also announced that they will have to stop. And an Apeldoorn institution has also indicated that it will stop clinical treatment.
The same reason is heard everywhere: big losses. PsyQ, for example, suffered a loss of 2.8 million euros in 2020.
Waiting lists are way too long
And that at a time when there is a lot of demand for this care and the waiting lists in mental health care are long. GroenLinks Member of Parliament Lisa Westerveld has put parliamentary questions to the minister. “We want the minister to show responsibility for financing. This is terrible news for clients, but also for the staff. Someone has to stand up and show direction.”
Stopping these types of treatments will only increase the waiting lists, says Westerveld. “And they’ve been way too long.” The MP is not only concerned for the clients, but also for the staff. “Closures like this also scare away good staff.”
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Payer determines
The payer decides, says the MIND foundation in a response. MIND is the umbrella organization that represents the interests of clients. “It is worrying that health insurers keep their hands on the cut and do not pay what is necessary,” says Mariëlle van den Berg of MIND.
“We understand that care must be affordable. But that should not be at the expense of the care that is needed. We are talking about the most vulnerable group of people here.”
Treatment saved life
The institution in Lunteren is also very well regarded. Former client Koosje (42) can talk about this. “Thanks to this intensive therapy I got back on the right track.” Koosje followed the therapy from August 2020 to April last year. “After years of fighting depression, I could finally go to Lunteren. I saw this as my last straw.”
Koosje is clear: the therapy saved her life. She can enjoy small things again and is busy with plans for the future. “I want to pick up my medical profession again. Thanks to the therapy I can do this.”
Patients and former patients have started an online signature campaign against the closure.
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Who is to blame?
What’s going wrong now? According to Marco Varkevisser, professor of market regulation in health care at Erasmus University, mental health institutions have been struggling for some time. “That’s because this care is very complicated. Because of that complexity, all kinds of players come into play,” says the professor.
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“Take hospital care: it is often much clearer than mental health care. For example, with knee or hip surgery it is very clear what needs to be done and how it should be paid for. But with psychological help, the diagnosis is by no means always unambiguous and There are more parties involved, especially in difficult care, which also makes contractual agreements between health insurers and care providers more complicated.”
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Treasurer
In the Dutch health care system, health insurers act as purchasers of care on behalf of their policyholders. To this end, insurers make contractual agreements with healthcare providers, such as a mental health institution. “The health insurers have the task on behalf of all of us to guarantee the affordability of healthcare. They are, as it were, the treasurers of healthcare. So they sometimes have to keep a tight rein. If they don’t, our healthcare premiums will become much too high, so it is too easy to place the blame unilaterally with health insurers.”
According to Varkevisser, the costs of mental health care have risen sharply in recent years. “That fact also contributes to the fact that health insurers pay extra attention to the costs and the institution is therefore finding it increasingly difficult.”
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Ministry response to the closures:
“These situations are primarily the responsibility of the care provider (the mental health care institution itself) and the health insurer. The role of the government lies with the Dutch Healthcare Authority and the Health Inspectorate. For example, they monitor compliance with the duty of care; existing treatments must be The ministry is there to ensure that the system functions properly, such as ensuring that sufficient psychologists are trained.
If a mental health institution does not function properly for whatever reason, the minister cannot intervene. That is up to the care provider and health insurer themselves. In general, when you close mental health institutions, you see that there are different backgrounds to what is going on. You can’t always compare them with each other, they deal with different problems.”
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