In the
Netherlands there seems to have been a rapid rise in incidents involving
"mentally confused" people. The reported number of such incidents
rose from 53,000 in 2013 to 60,000 last year and the Dutch are asking why.
Deutsche Welle, 27 July 2015
A phone
rings and community psychiatric nurse Theo Eberson speeds to his car. The
police want him to assess the mental health of someone they've just
apprehended. When Eberson arrives at the police station, Brigadier Mike de Wit
explains that his team has brought in an English-speaking man who banged on
doors in the stairwell of an apartment block and then got into a fight with an
angry resident who asked him to leave.
"We
want to see if there's anything we can do for him," de Wit says.
"And, if there's really nothing we can do, we have to put him back on the
street."
De Wit
unlocks the door of the cell and lets Eberson in. Eberson explains that he
comes from the community health department and that he'd just like to talk to
the man. But the man barely responds. He's lying on a bench in the cell,
shivering and has difficulties keeping his eyes open.
Cases on
the rise
Eberson
tells the man that he's going to call an ambulance to take him to the emergency
ward at the hospital. De Wit is used to this routine. He says he has seen a
rise in the number of people causing public disturbances in recent years.
 |
| A symbolic picture of a board covered in mathematical formulas to indicate a confused mind |
The number
of "confused" people is on the rise and there is less help for them
in society
"My
experience is that it's increasing," de Wit says. "There are more
people who have to live on the streets and less help for confused people. In
the end, they're on the radar and they end up here."
This kind
of incident is not just common in Amsterdam. Throughout the Netherlands, police
reported 60,000 incidents involving confused people in 2014, a whopping 13
percent increase from the previous year. The incidents, they say, are varied -
perhaps a small house fire or a person who decided to park their car on a train
or a tram line. That's the kind of slightly out of the ordinary incident that
suggests that someone may have been suffering from some kind of mental
disturbance. The rapid rise has sparked a national debate on what's causing the
problem and how to solve it.
Cuts to
mental health care
Jacobine
Geel heads the mental health association GGZ Nederland and believes that one
reason behind the increase in reported incidents is that the government has
been making budget cuts in the field of mental health care. The Netherlands is
rapidly decreasing the number of beds it has available in psychiatric units in
favor of outpatient care.
"There
are more people who are vulnerable and who need some form of care," Geel
says. "Often these people are living in their own houses. Budget cuts mean
fewer places where these people can go to have something to do or to meet
people."
More
problematic, Geel says, is the speed with which the system has to reorganize.
Geel recognizes the need for reorganization but she is hoping the government
will give health care professionals more time in which to do so.
Fred Ter
Meer knows what Geel is talking about. He heads a group of mental health
institutions called Yulius, based in the city of Dordrecht. The group is
responsible for about 16,000 patients. Ter Meer says he's already cut 35 of 200
beds and will have to cut more.
"We've
never had a waiting list, but now it's growing quite fast," Ter Meer says.
"When you're on a waiting list, for sometimes three months, there's a big
chance you'll find yourself in a crisis situation. Available beds for these
people will continue to be cut until 2018. So, we're only halfway. And I'm very
worried about how we're going to manage in the future."
Geel adds
that economic problems have contributed to the increasing number of mentally
confused people.
 |
| Some point to the effects of global financial decline as a contributing factor to mental illness |
"I
think the financial crisis of the past decade has caused problems for
individuals, and now those problems are really coming to light," Geel
says. "For instance, suppose that you're in a partnership and you lose
your job and then your partner loses his or her job and you have children. When
you're vulnerable to that stress, you can sink through the ice, as we say in
Dutch."
Geel says
constant images of conflict and wars on television screens and mobile phones have
also contributed to increased levels of stress for everyone. To find solutions,
Geel says, it's important to know more about those suffering from mental
confusion.
"Some
of these people probably do have a history of mental illness," Geel says.
"But a lot of them are probably just being crushed under the weight of a
very complex society. So we have to be very aware of the complexity and
diversity of this group and map it first before we start thinking about
solutions and how we can help."
'They don't
have solutions'
The term
"mental illness" can cover a very broad range of ills, and
"confused people" sounds even vaguer - so what does it really mean?
On the square outside her crisis center in Utrecht, community psychiatric nurse
Carina Stigter says that confused people are often in deep distress.
"Suicidal
thoughts, suicidal behavior, psychotic behavior and sometimes the abuse of
substances like alcohol and drugs," Stigter says. "What they all have
in common is that they don't have solutions to the situation that they're
dealing with. Or the people around them don't have solutions."
She thinks
that part of the problem - or at least an aggravation of these people's
distress - is when the police arrive to deal with what they deem a public
disturbance.
"They
are trained to deal with criminals and offenses," Stigter says. "And
they take these people into a police cell and treat them as a suspect. It
increases the suffering of these patients."
Deep
distress
That
happened to 19-year-old Felix, a slim and trendy young woman. At her home, she
explains in a quiet voice how she walked out of hospital for reasons she
prefers to keep private. Fearing that Felix might harm herself, hospital staff
called the police. She had just gotten home, she says, when two police cars drew
up and six officers stormed inside.
"They
jumped on me, handcuffed me and put me in the car," Felix says. "I
got angry. I shouted anything that came to mind - that I thought they were
idiots. I panicked. I felt I was being unfairly treated in my own home. "
Because of
her reaction, Felix was put into a cell.
"I had
to undress completely," Felix says. "I had to take off my wig, which
I wore at the time, and I found that very painful to deal with. There was no
explanation."
Felix says
she had to wait half an hour before people trained to work with mental health
patients came to see her.
"They
made me feel better and I settled down," Felix says. "I think that if
it'd been the other way around - that first the crisis service would have come
and then the police or no police at all - things would have been totally
different."
Changing
attitudes
Stigter,
the community psychiatric nurse, says she is trying to ensure that possible
patients receive mental health assistance before the police engage them. A year
ago she set up a program under which the police will contact her crisis service
if they're dealing with someone who's mentally confused before they try to
handle it themselves.
"Through
a structured-risk strategy, we make sure the people come here when they don't
need a police cell," Stigter says. "The relationship between the
mental health professionals and the police in Utrecht is very good, and that's
one of the success stories of this project."
In June,
Dutch Public Health Minister Edith Schippers announced that every municipality
should have a similar system in place by the end of this year. Despite this
move, Eberson, the nurse in Amsterdam, thinks that the Netherlands will have to
accept that mental illnesses will become more visible on the streets in to the
future.
"Now
we're closing down beds, which means there are more outpatients and more people
with psychiatric problems on the streets," Eberson says. "The
community has to get used to it and will get used to it."
Ter Meer,
of Yulius, says that would mean a big change for the Dutch, who are generally
accustomed to a relatively calm and quiet society.
"You
see a lot more confused people on the streets of Paris or London," Ter
Meer says. "But we're not used to it. So this is a big change for Dutch
society."
The change
is slowly altering Dutch attitudes to mental health in general - which is
perhaps fortunate because, until there is an integrated strategy to tackle this
problem, the reported rise in "mentally confused" patients could just
keep rising.
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