“Continuing on this path damages children for the rest of their lives,” says GroenLinks-PvdA MP Lisa Westerveld (44). “It costs lives while that is not necessary at all.” Together with GP Bernard Leenstra (36), the politician, who has been involved in youth care and mental health care for years, wants to start the “social discussion” about the disease, preferably as soon as possible.
Leenstra: “I deliberately use examples to get something going. Because we have to do something.” Such as: no longer medicalizing worries and setbacks among teenagers; and establish national specialist centers for serious cases. Westerveld: “I am frustrated that so little is happening. I receive emails with cries for help from children with, for example, an eating disorder for whom there is no room. And recently from a young person who needed a certain treatment that was not available, and who now saw the only way out was a euthanasia process.”
A quick ADHD diagnosis has a greater revenue model than offering specialist help to a child who is completely stuck
The failure of youth care has been established several times in the past year, including through damning reports from the Healthcare and Youth Inspectorates and from Justice and Security. “Too many young people do not receive protection, guidance and help, too late, or insufficiently,” the inspectorates wrote. One of the causes is that money and personnel end up in the wrong place.
The costs of youth care have “more than doubled” since municipalities were made responsible for providing youth care ten years ago, the Youth Authority recently reported. The number of youth care providers has “grown exponentially”. Not for intensive therapies and long-term care for children experiencing serious misery, but for help with parenting, stress or daytime activities. While “other solutions would be better suited,” the Youth Authority says: “Problems caused, for example, by performance pressure, financial worries in the family or problems with school often require more social solutions in the neighborhood, at school, at home or in the network.”
Member of Parliament Lisa Westerveld (GroenLinks-PvdA).
Photo Gabriela Hengeveld
Perverse incentive
Bernard Leenstra: “The supply of light care has increased insanely. It is not so much ‘you ask and we provide’ but ‘we provide so you just ask’. When I look for care in my practice for specific, mild psychological problems, I lose count of the number of providers. Within a week I can practically buy a diagnosis for ADHD. That is not right.”
Leenstra sees that the number of ADHD and autism diagnoses has increased enormously. “That is partly right, but problems in education or at school are medicalized very quickly. I once stayed in 3-havo. I did not check whether I might have ADHD. That is happening now. As a society, we must realize that things in life do not always go well.”
The incentive to continue studying as a doctor and to delve deeper into serious cases is now too small. We could make the reward more attractive
The system has a “perverse incentive,” says Westerveld. “Making a quick ADHD diagnosis has a greater revenue model than offering specialist help to a child who is completely stuck.” For the large number of healthcare providers, making simple diagnoses for empowered parents is financially attractive, she says. This is not specialist help for people in deprived areas. “Decentralization has led to market forces, with profit distributions by companies, and we have to get rid of that.”
Doctors should say no more often, Leenstra believes. “It would help them to get strict criteria. Think of the discussions during the Covid time, about choosing on the basis of which criteria, for example age or chance of survival, someone could or could not be admitted to intensive care. You could also follow this line of thought within youth care. I am advocating a large working group, with doctors but also parents, that will draw up boundaries. So that we can make choices and give doctors more tools when making referrals.”
For a child who remains in school, these stricter criteria may be annoying, says Leenstra. But a child who falls through the ice, is seriously ill or even dies is more serious. “The waiting lists for light care must be longer and those for more serious care shorter. There are many psychologists and orthopedagogues working in clinics for light care that we would be better off deploying elsewhere. The incentive to continue studying as a doctor and delving into serious cases is now too small. We could make the reward more attractive.”
General practitioner Bernard Leenstra
Beautiful specialist clinics
The decentralization of specialist youth care to municipalities has been “a mistake”, says Westerveld. “I saw a young person who got completely stuck, damaged herself and swallowed glass, for whom they could think of no other solution than to tie her up with straps to a bed in a clinic. I will never forget that image. I called everything and everyone to find out who should be responsible for this. I spoke to a councilor who literally said: I cannot afford the requested help, that is far too big a bite out of my budget. I say: ‘But she might die within a few weeks.’ She says: ‘Yes, but I can’t afford it’.”
“National agreements” must be made about these financial choices and they should not be left to municipalities, Westerveld believes. “We should set up specialist centers for complex, serious problems such as eating disorders, borderline or psychosis. Beautiful and well-organized, such as the Princess Máxima Center for children with cancer: with education and space for parents to stay the night.”
Let’s charge VAT on alternative treatments whose effectiveness has never been proven and use the proceeds to give all children a breakfast at school
Instead, children with psychological problems end up “in closed youth institutions that sometimes look like a prison,” says the politician. “You can count on your fingers that a child comes out worse than when he goes in.”
According to Leenstra and Westerveld, both politics and society must consult themselves. “There is enormous pressure to perform,” says Westerveld. “I heard the story last week of a girl who played in a musical at the beginning of high school, and that her father was furious afterwards because she had not sung completely in tune. What kind of a jerk are you?”
She lacks “guidance” from the national government. Westerveld: “Let’s have more understanding for young people who sometimes do something wrong, or are different. We can handle social media better. Children suffer from online bullying. And if you are sensitive to how you look, you will continue to be exposed to videos and videos by the algorithms. challenges about becoming as thin as possible, and an even poorer self-image arises.”
Practical solutions
Much youth care can be avoided, say Westerveld and Leenstra, if politics and society put more effort into strengthening ‘social cohesion’. Leenstra: “In my consultation room I see that problems sometimes have to do with poverty. What would help enormously is to ensure that all children at school have had breakfast. Hungry children run into problems. I’m throwing the ball into the woods: let’s charge VAT on alternative treatment methods whose effectiveness has never been proven. Nice to have. And let us use the proceeds to give all children breakfast at school. That’s possible, I’ve done the math.”
Instead of medicalizing social problems, much would be gained by “targeted” and “very concrete” research into what a child needs. Leenstra: “I heard from a little boy who was able to survive in regular education through a daily extra hour of support during lunchtime. His family moved. A year before the move, the new municipality had already asked for an extra hour. And guess what? Not arranged.”
Westerveld: “I sometimes visit schools for special education, with children who live some distance away and for whom student transport does not work very well. What turns out? Those children can cycle to school with some supervision. Their parents just don’t have the money for that. So? Give those children a bicycle. Make them self-reliant.”
Leenstra advocates a broadly composed “do-tank” that searches for practical solutions. “Investments pay off,” he says. “If we can contribute to the reduction of poverty, debt and stress, and if a child is well attached both to the parents and socially, then that is the best investment you can make.”
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