The first contact that never happens

A GP in 2021 spent the better part of an afternoon trying to get one patient through a door. The patient had been referred, judged to need specialist help, and sent on with the thing every patient is sent on with: a name, a number, a place to call. The provider wrote back that they could not offer an intake appointment, the wait already past the four-week norm. So the patient called the insurer, who pointed back to a provider, who pointed to another provider, who pointed back. Three hours of a doctor's day, and at the end of it the patient had still not reached anyone (GGZ Totaal, 2021). Not turned away, exactly. Just never let in.

We have a phrase for this in Dutch, "van het kastje naar de muur," from the little cupboard to the wall, and it is one of the most honest things the language does. It describes a person in motion who arrives nowhere. The phone that rings out, the email that goes unanswered, the callback that never comes. Anyone who has tried to get themselves or someone they love into care knows the feeling in their body before they can name it.

The problem is not the phone

But the phone is not the real problem. It is the symptom of one. Here is what I am more curious about: what happens, clinically, in the stretch of time before a person ever reaches a clinician at all?

The official Dutch data splits the wait into two phases that the public tends to fold into one. There is the aanmeldwachttijd, the wait between a referral and the first intake conversation, with a four-week norm. And there is the behandelwachttijd, the wait between that conversation and the start of treatment, with a ten-week norm. The first is "can I even reach the door." The second is "the door opened, now I wait for the room." Most of the public conversation is about the room. The harder failure is at the door.

The numbers say so plainly. Per the NZa's Informatiekaart for October 2024, 67% of intake-appointment waiting positions breach the four-week norm, against 38.7% of treatment positions breaching the ten-week one (Nederlandse Zorgautoriteit, 2025). Read that twice. The first contact is the worse-performing of the two. And of 108,878 total ggz waiting positions, 72,443, about two-thirds, are people waiting just to be seen for the first time. Not waiting for treatment. Waiting to be looked at once.

Nobody owns the person who is waiting

So who is holding that person while the phone rings out? The regulator has answered, and the answer is the quiet horror under the statistic. The Inspectie found that providers had made insufficient agreements about who is responsible for which care while a client sits on the waiting list (Inspectie Gezondheidszorg en Jeugd, 2023). In plain words: during the wait, no one owns the patient. The file is open, the place is held, and there is no clinician whose job it is to notice if the person on the other end goes quiet.

Where does the holding happen instead? It falls on the general practitioner. In the LHV's 2025 survey, 93% of GPs reported few or no options to refer to specialist ggz, and they were spending hours each week on the bridge care that fills the gap (Landelijke Huisartsen Vereniging, 2025). The GP becomes the holding pen for a queue they did not build and cannot move. And the Trimbos and Nivel review of the wait found the same shape from the patient's side: complaints worsen for most people who wait, and the burden lands on GPs and practice nurses (Schutjens, Nuijen & Magnée, 2024). The waiting is not a neutral pause. It is a stretch of time in which the symptoms get heavier and no one is assigned to watch.

The first reachable act

Think for a moment about who the unanswered phone belongs to. Not a casual caller. Someone who, on average, took weeks to decide that the thing they were carrying was heavy enough to ask a stranger for help. They rehearsed the sentence. They picked a quiet hour. They dialed. What did the silence on the other end say to that person? Not "we are busy." It said "the courage you spent was wasted." For someone at the exact moment of asking, an unanswered first contact is not an inconvenience. It is the door closing.

Now make it yours, because the number is easy to keep at arm's length. Picture your own intake list, the people who have not yet had a first conversation with anyone. Two in three of all the waiting people in this country are in exactly that position, still waiting to be seen the first time. Some of them are trying to reach you right now, in the hour before your next session, and the system has given them a ringing tone and a wall. The 72,443 is not an abstraction. It is the people who took the courage to call before they ever got to sit down.

So what is reachability, really? It is the first therapeutic act. The warmth of being answered, the relief of a human voice saying "yes, we have you," is not the soft part before the real treatment begins. It is the first dose of it. And the Dutch system, on its own admission, fails that act at the threshold, before any clinician is ever in the room. None of this is one therapist's doing. The queue is the symptom of a system carrying more people than it can reach, and the people most in need of being reached are the ones standing quietest at a door that is not answering.

The waiting list is the part of the illness we have learned to count. The part before it, the door nobody picks up, is the part we have not. But it is the same person. And they are still on the line.

Researched by Freudche.