What part does a protocol play?

The word protocol often calls up the picture of a route map for professionals. A standard diagnostic step-by-step plan, a guideline, a treatment pathway. Handy, because it seems to bring structure to the chaos. But there is a danger in it too: that a protocol turns into an autopilot. Someone tells their story, is placed in a category, and off goes the treatment protocol. Without much room left for meeting, listening, searching together.

Yet a protocol in mental health care can also mean something quite different. Someone in mental distress often experiences life as narrowed to a tunnel. You feel at the mercy of something that is compelling and holds everything in its grip. In such a situation a personal protocol can give support. Not because it is imposed on you, but because you worked on it together with your care provider. It is a fixed way of working that helps you get a grip and take a step out of that tunnel.

A protocol only works if you recognise yourself in it

Take Laura, who has anxiety attacks. She discovered that it helps her enormously to have a morning protocol: getting up, ten minutes of stretching, making coffee, and then writing down three things she wants to give her attention to that day. It sounds simple, but this fixed ritual gives her something to hold on to and prevents her from being flooded straight away.

Or think of Jamal, who hears voices and often feels powerless because of them. Together with his support worker he made a protocol: as soon as the voices become too compelling, he calls his sister, puts on his headphones with music that calms him, and goes for a fifteen-minute walk. It is not a miracle cure, but it does help him not to go under.

And then there is Marijke, who noticed after a depression that she quickly fell back into worrying. Her protocol consisted of five fixed appointments with a creative therapist. Not because that was required ‘according to the guideline’, but because she felt: when I use my hands to make something, air comes into my head. That became her way of getting out of the tunnel.

So the key word is: together. A protocol only works if it is something you recognise yourself in, something you helped to shape. Then it is an ally and not a straitjacket.

A protocol that invites, and does not prescribe

Perhaps we have to win back the word protocol in mental health care. As a shared agreement that gives direction, and not as an instrument of bureaucracy. A protocol that invites. Then it is a friend that helps you find new room, and not an enemy that limits your freedom.

And you? What could your personal protocol be: a small fixed ritual or agreement that helps you get out of the tunnel?

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

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Blogs by Jim van Os can be read here

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