‘Youth care, the system, is broken. That is also the opinion of people who were enthusiastic about the Youth Act in 2015. And yes, I also think that the system cannot continue in this way. This urgently needs to be addressed. Complex care is my priority. There are often long waiting lists for this. That has to change.’
Maarten van Ooijen (32) is determined. The State Secretary for Health, responsible for youth care, is going to reform youth care. Together with the municipalities, which have been responsible for the implementation of youth care since 2015, and their lobby club, the Association of Dutch Municipalities.
In 1997 one in 27 children under the age of 18 called on youth care, in 2015 this was already one in ten and last year one in seven. That is 13 percent of all young people, 450 thousand, according to the Central Bureau of Statistics.
What is going on?
‘It’s a combination of things. In general, we may have forgotten that there can be serious setbacks in life. We sometimes have the expectation that a care provider can offer something that he cannot offer. I mean, there’s no formula to get rid of depression, for example. Probably a circle of friends, people close by, or a confidant with whom you can actually share things work best.
‘We also set the bar very high for young people – in terms of social skills, emotional skills, identity – you name it. We should also be able to say: take it easyfine if you make a miss, as long as you learn from it.
‘But the youth care system also plays a role. Since 2015, it has provided space for healthcare providers to recruit clients. This is possible because many municipalities have a so-called open housetender for light youth care. All healthcare providers who register will receive a contract and they will then start recruiting customers. This is often done with the best of intentions. People have come up with something, think it’s effective. For example, market forces have been introduced that were not foreseen in 2015. Private equity investors have entered that market. That leads to excessive profits, excesses. But that was and is not the intention. In recent years, 1,500 youth care providers have been added. There are now 3,500. That’s really mega.
‘An example. A school has contact with a care provider to help students with stress during their final exams. The parents are told: it costs nothing, the municipality pays. We must ask each other whether youth care is intended for this. Isn’t tension and stress part of an exam?’
Do you want to abolish simple, light youth care?
“Well, um, let me put it this way. One in seven children with youth care is not healthy. The major growth in the demand for help is in light youth care. I’m not going to cats at that school or that provider. I still remember that school. Also understand the provider, maybe it’s helpful. But from a social point of view it is undesirable.
‘If one in seven children receives youth care, things have to change. It is absolutely impossible that the number of healthcare providers can increase indefinitely as a result of this open-house tender.
‘I also look at youth care in relation to education. Youth assistance is now organized individually. Sometimes it can be a collective, that aid workers come to schools. Those are not settled per individual with an hour for Pietje, half an hour for Marietje and Mohammed not because he comes from another municipality. No, someone who gets the professional freedom. He can refer you if there are more serious problems.
‘One family, one plan, one care provider, was the idea in 2015. Each municipality did this in its own way. Sometimes the child has a problem because there are difficulties at home – money worries, debts, drugs, relationship problems. Now we know what works well. In Utrecht, where I was alderman, the teams handled 80 percent of the care demand themselves. So no officials who test everything, but professionals who know what to do. They must get their freedom back.
‘Caring for young people with serious, complex problems is an absolute priority for me. The demand for care has actually been quite stable over the years. It’s only a fraction of the total.
‘During a working visit, I spoke to a mother and her daughter who had an eating disorder. The mother told how she saw her child deteriorate week in, week out. “She walked into the ravine and there was nothing I could do.” At the same time, she was on a waiting list for a clinic for weeks. While we know about eating disorders: the sooner you catch it, the faster and more effective treatment works.’
What can you do about it?
‘The organization of specialized youth care really needs to change. Municipalities are now working together to contract this care in 42 clusters, but there should be much less. Healthcare institutions now have to deal with dozens of municipalities, each with their own tendering regime, funding and professionals who are accountable to the municipalities. This is being cut by large groups of municipalities to conclude standardized contracts, with freedom for the professional.’
In The Hague, everything starts and ends with money. In 2015, youth care cost 3.6 billion euros, now it is 5.6 billion. Is that less?
‘The coalition agreement contains a cutback of 511 million euros. Talks were held with municipalities about a reform agenda that would save a billion euros in the long run. But when the coalition agreement was announced, the municipalities left the table. Now we have promised municipalities that we will not cut those 511 million from their budget. This will be, for example, a personal contribution for some care or a maximum duration for some treatments. We study on that. But consultations with municipalities are now starting again.’