May 27, 2026 · 6 min read
The patient did not leave. The system let go.
In Dutch mental health care, an ending is not always the patient drifting off. The system terminates the relationship through structurally different mechanisms: a patient refused entry for being "too complex" after a long wait; a short-term trajectory that closes at a by-design 8 to 12 sessions; a financing ceiling that, while it was live, stopped treatment for 33% of affected people in the GGZ and blocked new care for 69%; and disputed discharges a tribunal sometimes judged careless, including one referral made without asking the patient. The financing cutoff is now being dismantled for independent practices. What stays is the question of how an ending is done, because a cold ending compounds the wound and a warm one does not.
May 27, 2026 · 6 min read
Every room belongs to someone. The space between them belongs to no one.
Van het kastje naar de muur is not a service failure. It is the predictable output of a system where nobody is assigned to own the person between rooms. The Inspectorate found providers made insufficient agreements about who is responsible while a client is on a waiting list. The State 2025 IBO calls the system onhoudbaar and names versnippering across four separate laws as a core cause. And the GP, the one fixed point, has become an involuntary holding pen: 93% of GPs say they can barely refer to specialist GGZ, and they spend around 3.7 hours a week on bridge care outside their remit. Every hop restarts because every room belongs to someone else, and the seams belong to no one.
May 27, 2026 · 5 min read
The patient is the one person in the room with no vote on their own care
Shared decision-making is a defined, four-step clinical standard (Stiggelbout, 2015; Elwyn, 2017) and a decade-long national project in the Netherlands. The field's own senior researchers concluded in 2022 that the gains are real but uneven, and that the standard has not reached all patients. MIND's established position puts a number on who is left out: more than two in three ggz clients report no clear agreement on their own diagnosis and treatment, and more than 60% were never told a decision needed making. The patient is the one person in the room with no vote on their own care, and the data the field collects on itself says so.
May 26, 2026 · 8 min read
The waiting list is the part of the illness nobody counts
The wait between asking for help and receiving it is administered as a neutral queue, an "in progress" on a form. The evidence reads it differently. Longer waits for early psychosis care tracked worse 12-month outcomes (Reichert & Jacobs, 2018), and a network meta-analysis found being placed on a waitlist did worse than no treatment at all, with disappointment proposed as the mechanism (Furukawa et al., 2014). After referral, disengagement is a risk marker, not passivity: patients with mental-health conditions who missed more than two appointments a year had an 8.37-fold higher mortality (McQueenie et al., 2019), and reaching psychiatric care within seven days of a suicide attempt was associated with roughly half the reattempt risk (Kim et al., 2022). All of it observational, all caveated by its authors. In the Netherlands, 108,878 ggz waiting positions stood open in October 2024 (NZa, 2025). The wait is the least-counted stretch of the illness.
May 25, 2026 · 6 min read
The gap between two therapists is where the patient is quietly lost
A referred patient waits weeks between one therapist and the next, and many do not arrive. Studies have long found that of 100 people who contact a clinic, only about 33 reach a first therapy session; baseline premature termination sits at 19.7%; and when the therapist changes, dropout in one inpatient sample rose from 7.1% to 40.4%. In the Netherlands, 108,878 waiting spots stood open in October 2024, with 67% past the intake norm and an average 28-week wait for personality disorders. The structured transfer leaves no lasting symptom mark, but the recovery window is real, and the dropout that happens inside it is the part nobody counts.