The waiting list is the part of the illness nobody counts

There is a word that does a lot of quiet work on a clinic's screen. A person has reached out, been assessed, been judged to need more than a first conversation can give, and now their file says the same thing it says for everyone ahead of them and everyone behind: in progress. It sounds like motion. A line in a queue, a referral sent and received, a place held. The word tells you nothing is wrong. The person has been seen, the system is working, the help is coming. All that is left to do is wait.

But what is the wait, for the person living inside it? Not the file's version. The file thinks the wait is a pause, a held breath between two real events, the asking and the receiving. The evidence thinks something else. It thinks the wait is one of the events.

The wait is not neutral time

Start with the cleanest finding, because it is the one that should unsettle us most. In a network meta-analysis of 49 trials of cognitive behavioural therapy for depression, patients assigned to a waiting list did worse than patients given no treatment at all (Furukawa et al., 2014). Worse than therapy you would expect. But worse than nothing? The authors are careful, and so should we be: they call the finding exploratory and say it needs more evidence. But they propose a mechanism, and it is the kind that lingers. Why might being told to wait hurt more than being told nothing at all? Because the waiting may quietly switch off the things a person does for themselves, the small acts of looking after oneself, when some help is now officially on the way and they are, by definition, in the queue for it. The disappointment of waiting may itself be doing harm. The waitlist as a nocebo, an inert thing that hurts because of what it makes you believe.

Sit a longer wait next to that. Across 8,949 patients in 48 English mental-health trusts, those who waited longest for early intervention in psychosis had measurably worse outcomes a year later than those seen soonest, with waits past three months tracking the steepest decline (Reichert & Jacobs, 2018). Here the authors plant the most important flag in this whole piece, and I want to keep it planted: this is observational. Does that mean the wait caused the decline? No. They write that unobserved severity may explain both the longer wait and the worse outcome, the sicker person waiting longer and faring worse for the same underlying reason. So nobody has shown that waiting causes the decline. What they have shown is that the longest waits and the worst outcomes keep arriving together, often enough that a careful health economist felt obliged to report it. The wait may be doing harm, or it may be marking the people already most at risk. Either reading is a reason to look at the wait, not past it.

The scale, said plainly

In the Netherlands there were 108,878 ggz waiting positions on the first of October 2024, with 67% of intake positions past the four-week norm and average waits running up to 28 weeks for personality-disorder care (Nederlandse Zorgautoriteit, 2025). Read that number exactly as the NZa asks it to be read: positions, not people. Roughly one in five with the same care question sits on more than one list, so the figure counts places in queues, not distinct human beings. It is still 108,878 places where someone is waiting.

And the sober national backdrop, which I will set down carefully and then leave alone: 1,849 people in the Netherlands died by suicide in 2024, on average five a day (Centraal Bureau voor de Statistiek, 2025). That figure is its own statistic. It is not a count of people lost to waiting lists, and nothing in the research lets anyone connect the two numbers. I name it only so the stakes of the gap are not abstract. The waiting list is not a customer-service problem with an unusually long hold time. It is a stretch of time in the lives of people who are unwell.

Disappointed and gone is a risk state, not passivity

Here is the second thread, and it changes how the empty side of the waiting list reads. When a person who has been referred drifts out of contact, what do we assume? That they got better? Got busy? Were never that committed? The data tells a colder story. In 824,374 Scottish patients across 11.5 million appointments, those with a long-term mental-health condition who missed more than two appointments a year had an 8.37-fold higher all-cause mortality than those who missed none (McQueenie et al., 2019). The authors are emphatic that this is not a simple chain of cause and effect: the things that make appointments hard to keep, the difficulty concentrating, the substance use, the sheer weight of the illness, are the same things that raise the risk of dying. So missing appointments does not kill people. It marks the people most in danger. The person who stops showing up is not the safe one in the cohort. Statistically, they may be the one to worry about most.

Look closer at the most dangerous version of that disengagement and the picture holds. Among 5,640 people in South Korea who had harmed themselves, the lowest survival was among those who reached psychiatric care late or not at all (Kim et al., 2023). And among nearly six thousand who had attempted suicide, reaching psychiatric care within seven days was associated with roughly half the risk of a further attempt (adjusted HR 0.51) compared with those who got there later (Kim et al., 2022). Both teams flag the same limits: these are claims-data cohorts, missing the clinical detail that would sharpen the picture, and they read it as association, not proof. So the honest sentence is not "fast referral prevents suicide." It is quieter and still heavy: how quickly a person reaches care, and whether they reach it at all, keeps company with whether they are safe.

So what was the waiting list, again? A neutral queue, the screen said. But put the threads together and that word stops holding. The wait can worsen the people inside it, and the people who go quiet on the far side of a referral are not the ones who needed it least. The disappointment the file cannot see is the same disappointment one study named as a possible mechanism of harm. "Disappointed and gone" is not the absence of a problem. In this literature it reads like the shape of one.

I will name the human scale honestly, because numbers can hide it. In a charity survey of around 450 people who said their mental health worsened while waiting, roughly one in three reported a suicide attempt during the wait and nearly three in four reported suicidal thoughts (Rethink Mental Illness, 2025). That is a self-selected survey of people already in distress, not a rate that applies to everyone on a list, and it must be held exactly that loosely. But it is the voice under the statistics. These are not positions in a queue. They are people for whom the held breath got very long.

What we owe the person in the gap

The system is good at counting the things it can see. Beds. Positions. The four-week norm. The day treatment begins. What it has never built a column for is the person living through the wait, between the asking and the receiving, in the stretch the evidence keeps telling us is not as quiet as the screen pretends. None of this is any clinician's failing. The wait is long because the system is saturated, because therapists are already carrying more people than they can reach quickly, and the queue is the symptom of that, not anyone's carelessness.

This is the gap Freudche was built to sit inside. The first part is The Tussen, the in-between: quiet company across the wait, something that keeps a person connected to their care rather than drifting, so the time between asking and receiving is not simply empty, isolating time. The second part is for the therapist who will eventually open the door. Freudche surfaces early signals from that span, so that when the room finally opens, the therapist is not meeting a stranger cold. The idea is that they arrive already oriented to the person in front of them, rather than starting from a blank page after a wait that did its work in the dark. That is the whole of it, plainly: company that keeps a person on track, and a clinician who arrives knowing something about them. Not a replacement for the room, and not a fix for the queue. A way of making sure the wait is not spent entirely alone.

If you take one number from all of this, take the smallest one. Roughly one in five people sitting on those Dutch lists appears on more than one of them, which means the headcount of human beings behind 108,878 positions is its own uncounted thing. Picture the people, not the positions. Now count the ones on your own list, the ones you have not reached yet. What have we built for the time they spend waiting? For most of them, the honest answer is one word on a screen that says nothing is wrong.

If you or someone you are sitting with is in crisis, you do not have to wait for the room to open. In the Netherlands, 113 Zelfmoordpreventie is free and reachable around the clock at 113.nl or 0800-0113. Anywhere else, findahelpline.com lists a service near you.

Researched by Freudche.