Ned Tijdschr Geneeskd 2018 12 5;162. Epub 2018 Dec 5.
Universitair Medisch Centrum Utrecht, Psychiatrie.
A disorder-focused approach in mental healthcare in the Netherlands, combined with a disorder-linked reimbursement system, risks medicalisation of stress-related mental variations that may result from the current societal pressures to be beautiful and successful. Furthermore, a disorder-linked reimbursement system may lead to inappropriate treatment, dictated by group-based guidelines tied to DSM-classifications rather than the complexities and contexts of individual needs for care. Finally, there can be both over- and under-treatment as a result of a free-market healthcare system in which quality of care is equated with symptom reduction. We propose several adaptations, including, firstly, creating eCommunities offering self-help and peer support and, secondly, reinventing mental illnesses as vulnerabilities primarily requiring a 'heal and deal' approach of strengthening resilience as well as reducing symptoms. The conceptual foundation of mental healthcare as a free-market economy, and the current quality system, should be reconsidered. It is fundamental that reimbursement should not depend on arbitrary diagnostic algorithms of disorder.
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