Dutch Pioneer Community Care in Psychiatry

   (from 1945)

   Although the Dutch Mental Hygiene Movement (Nederlandsche Vereeniging ter Bevordering der Geestelijke Volksgezondheid) had been founded in 1924, it remained an anemic organization with little influence. In August 1945, however, just at the end of hostilities, the Minister of Social Affairs asked the mental hygienists to suggest a national program in mental hygiene for knitting back a country that had been badly rattled by wartime events. The organization responded with proposals focusing on group treatment, early treatment, and community care. At the International Congress on Mental Health in London in 1948, the large Dutch contingent led by Henricus Cornelis Rümke (1893–1967), professor of psychiatry at the University of Utrecht between 1936 and 1963 and who had been prominent in the "Utrecht School" of phenomenology and anthropology, returned home filled with determination to promote not merely mental hygiene but mental health. This reformist vigor penetrated the various Roman Catholic, Protestant, and "non-confessional" "pillars" of health care into which Dutch society was then split (the famous "pillarization" system of Dutch social organization). One scholar writes, "Beginning in the sixties, most [pillarized] psychiatric hospitals witnessed an astounding proliferation of all kinds of therapeutic communities, rehabilitation units, short and long term treatment programs, substance abuse clinics, and services for people with behavioral problems and personality disorders" (Schnabel, in Porter, ed., Culture of Psychiatry, p. 32). These were not, however, linked to deinstitutionalization, a process that began later in The Netherlands. Then in 1982, the ties with the various pillars were cut, and under the influence of Kees Trimbos (1920–1988), professor of social psychiatry in Rotterdam, and like Rümke a Catholic, outpatient psychiatric services became organized into community health-care centers focusing on psychotherapy and called "RIAGGSs," the Dutch equivalent of Regional Institute of Ambulatory Mental Health Care. More attuned to patients with lesser psychiatric problems, the RIAGGS kept their distance from patients with serious disorders. Yet, the almost 60 RIAGGS that developed became what was probably the world’s first well-integrated system of ambulant mental-health care. Finally, in the 1990s, they did move closer to the hospitals in the context of deinstitutionalization.