In almost every Dutch general practice, people with mental problems can contact a so-called mental health practice assistant (POH-GGZ). This should reduce the pressure on mental health care by first treating people at their GP before they go to specialized mental health care. In practice, the positive effect of this is much less great than expected, according to research by Roger Prudon, econometrician and university lecturer at the British Lancaster University, published on Wednesday in economists’ journal ESB.
His research indicates that the use of practice assistants does not demonstrably help to improve the mental health of Dutch people. The introduction of the POH-GGZ has even directly led to more pressure on healthcare, Prudon dares to say.
The researcher sees that practice assistants mainly treat people who would initially receive no psychological help at all for their problems. “I do not see that the group currently treated by the POH-GGZ ends up in mental health care less often. The severity of their problems is also not lower if they have been to the practice nurse.”
The idea was that having a practice nurse would cause people to have fewer problems in the long term. I can’t find thatRoger Prudonresearcher Lancaster University
Healthcare costs are also not decreasing, says Prudon. People who visit both the practice assistant and the mental health care provider receive double care. The treatment they receive in mental health care is not cheaper because their problems do not decrease even though they have already seen a POH-GGZ. Prudon: “The idea was that people would have fewer problems in the long term because of a practice assistant. I don’t think so.”
His conclusion is remarkable, because practice assistants were seen by the government and insurers as a solution for the clogged mental health care system – known for its long waiting lists. Since 2008, these support workers have been deployed en masse at general practices. With almost 9,000 practice assistants in 2023, the number has doubled compared to 2016. The National Association of General Practitioners (LHV) writes on the website that general practitioners can help “many more patients in an accessible way” by deploying a POH-GGZ in practice.
Easier mental support
Most practice assistants have completed a one- or two-year POH training course and have a background as a doctor’s assistant or nurse. They must help people with minor complaints without immediately calling in a psychologist – mainly through in-depth conversations, sometimes through treatment or a referral to (specialist) mental health care. They would help people to better bridge the waiting time for specialist help by regularly talking about problems.
Since 2014, help from a psychologist or a mental health institution has not been reimbursed in basic insurance, but the practice assistant is. That is why the POH-GGZ should make it easier to seek mental support for a larger group of people.
Between 2011 and 2021, the number of users of POH-GGZ increased from 100,000 to 600,000 people per year. “In the same period, the number of patients in basic and specialized mental health care has remained approximately constant,” Prudon writes in his publication.
No better health
Prudon received data for his research from Statistics Netherlands (CBS) and the Netherlands Institute for Healthcare Research (Nivel). The dataset contains 1.2 million people who had a GP consultation for their mental health between 2011 and 2021. Of this group, approximately 400,000 people received some form of treatment for their mental problems in the first year after going to the doctor.
Based on the data, Prudon concludes that patients do not experience better health within two to three years as a result of conversations with the practice nurse. Health differences are also not reduced by the presence of the POH-GGZ: people who already used mental health care relatively often also visit a practice nurse more often, Prudon sees. Practice assistants are less popular among people who make little use of healthcare.
Previous research by Prudon showed that the chance of finding work decreases with every month that someone has to wait for specialized mental health care – according to this research, POH-GGZ also does not offer any improvement for that labor market position.
Also read
Lots of mental problems
Despite these findings, the researcher would not simply abolish the practice nurse, he says. “The question must be: what can we do to help those 600,000 people?” In September, a Research by the national government shows that almost half of Dutch people experience mental problems, and that more and more people are seeking help for psychological problems.
The introduction of the mental health practice assistant has certainly led to more pressure on healthcareRoger Prudonresearcher Lancaster University
The solution may be “budgetary,” Prudon thinks. The POH-GGZ costs 360 million euros every year – a lot of money for the “limited health effects” he sees. That money would be better invested elsewhere in mental health care, the researcher thinks. For example, by expanding the capacity of mental health institutions and reducing waiting lists.
Longer waiting times
That’s easier said than done, because “we don’t know exactly how to shorten waiting lists,” says Prudon. According to him, it can help to change the ‘financial incentive’ for mental health institutions. Specialized institutions more often treat patients with less serious problems because that care is cheaper. That is a growing problem and one of the causes of the long waiting lists. Prudon: “If you were to change that, the waiting lists could possibly shrink.”
The average waiting time for treatment is for all forms of mental health care longer than the permitted 14 weeks. People with complex psychological problems wait the longest for care: in specialist mental health care the waiting time could increase to 32 weeks in May, for less serious complaints in basic mental health care people had to wait up to 17 weeks. In April, the ‘Stichting Recht op ggz’ started a lawsuit against the Dutch State because of the long waiting lists. According to the foundation, the government would violate human rights by making patients with serious mental illnesses wait so long for help.
Also read