Let’s look at the numbers. The spend towards the mental healthcare sector within the Dutch Care Insurance Act went up to 5.8 billion euros, the highest ever. But also, around a hundred thousand people on a waiting list. More money than ever, but longer waiting lists than ever. If money was the answer, we would have found the solution by now.

Dutch mental healthcare funding: Fighting a losing battle

So what’s going on? I think we separated treating, and living. What I mean is that the system pays for sessions that take place in a little room, and are focused on the reduction of symptoms. 45 minutes of therapy once every fortnight. But what to do with the other 335 hours of those two weeks? In those, in that everyday life, is where recovery happens. Or it doesn’t.

If someone suffers for a long time, we rarely ask: how do we reduce their symptoms? The main question is: how do I design a life, with these sensitivities and talents? How do I live, work, belong, and what does it all mean? Those questions shouldn’t be an afterthought in the treatment. Those questions should be the main focus of the treatment.

And then a comparison I regularly refer to. The cardiologist has a brilliant success rate, not in the consultation room but in people’s lives: exercise, healthy eating, monitoring blood pressure; public health. In the mental healthcare sector, we do the opposite: we wait till someone gets stuck, put that person on a waiting list, and offer them a protocol. Treating the symptom, not the cause.

Working together in real life

The result of that separation of treating people and real life, is a spiral many people get stuck in. You enter with a problem, you get a diagnosis and then some treatment. The treatment is focused on symptoms, and everyday life becomes a side issue. The symptoms return, and you get more treatment. Dependence increases, demoralisation grows, but nobody did anything wrong. It’s the way mental healthcare is designed that does this, not the people.

Does this mean we don’t need any experts? On the contrary. We need them more than ever. But we need them to focus on the patient’s everyday life. A psychiatrist who helps you think about what medication you need, as a part of a plan to get you back to work. A psychologist that links trauma treatment to someone’s social circle. A social worker, an experience expert, and a mental healthcare worker that know each other and work together around the same person. Expertise that contributes to everyday life, not ticks a box in a treatment room.

Building an Ecosystem Around Mental Healthcare Recovery”.

This type of care doesn’t just happen, you need to build on it. We’ve have been trying this since 2022, in a few pilot regions of GEM, the ecosystem of mental health. The idea: you don’t redesign the mental healthcare sector, but build an ecosystem around it, in which recovery happens. Recovery academies, support groups, social work, experience experts, and online platforms as equal  building blocks, with the mental healthcare sector that participates flexibly and consultative. Social, existential, and medical don’t function aside each other, but with each other. Social holding as a method: people who hold you close whilst you experiment with your life.

Why does that go so slowly?

Because the money is in silos, and so is the way of thinking. The health insurance companies pay for treatment, the council pays to participate, and those two sources of money barely know each other. Everyone defends their own budget. So yes, keep the means with the people that need it. But the real gain is not putting more money in the same silo. The gain is in putting more money towards life, than towards treatment.

I think this is the main task of the coming decades: are we getting a healthcare system that focuses on life, in which the experts help people to design their life? The answer cannot be found in a policy document. The answer lies in regions where people, councils, mental healthcare workers, and experience experts work together, and where we measure in results. Give those regions the space, time and funding they need. There is work to be done.