Tag Archives: Netherlands

Mental Health Care in the Netherlands #Write31Days

31 Days of Mental Health

My husband and I have been in the process of a possible move for a few weeks. In fact, we’ve been contemplating moving for months. Last week, however, my husband informed me we’re high on the housing corporation’s list for a house in a tiny village on the “right” side of Arnhem (that is, east from it of course). My husband has been wanting to move back to that area ever since we moved into our current apartment in 2012. Today, we got the housing corporation’s green light for a visitation, at which point we can decide whether we want the house or not. With the possible move coming so close, my husband started worrying about the possibility of me getting home care in a tiny, rural village. This gets me to today’s topic in the #Write31Days challenge on mental health: the mental health care system in the Netherlands. I will focus on adult care, because it’s complicated enough without adding in the Youth Act and what not.

There are basically three laws governing mental health care in the Netherlands. First is the Long-Term Care Act. The Long-Term Care Act covers institutional care that is essentially deemed lifelong. Examples are nursing homes, group homes for people with developmental or physical disabilities, or psychiatric supported housing placements. Originally, all people requiring long-term, institutional care because of a disability or illness were covered, except for those with psychiatric illnesses. Apparently, the government thought that a psychiatric illness cannot possibly be lifelong. Before the Act took effect, however, this problem was solved. Now, if a mentally ill person has been in inpatient treatment for three consecutive years, they may qualify for institutional care through the Long-Term Care Act. I have yet to find out whether, should I fall apart while living with my husband and need to be institutionalized, I’ll first need three more years of inpatient treatment before I can go into supported housing. After all, I already got those three years of treatment.

Next is the Health Insurance Act. Health insurance is mandatory in the Netherlands and, though insurance companies are private, they cannot turn anyone down for the “basic package”. Basic health insurance covers GP visits, care by medical specialists, most medications, hospitalization, and other care deemed necessary. Outpatient mental health care, partial hospitalization and the first three years of inpatient mental health treatment are covered by basic health insurance. So are most but not all psychiatric medications. For instance, benzodiazepines are not covered except if the patient requires “high doses” of them because of “severe mental illness” (or some other, non-psychiatric indications). I assume they essentially mean that it’s okay as long as the patient needs chemical restraint.

The final law covering mental health is the Community Assistance Act. This law is implemented by each local government, so each locality gets to decide which people qualify for funding for care. They also decide whether people have to pay a copay. The Community Assistance Act covers housekeeping services, day activities and independent living support, as well as short-term institutional care and respite care. I will need day activities and most importantly independent living support through the Community Assistance Act. Whether you get care and, if so, how much is determined through a “kitchen table meeting” with a “social consultant”. Family members are supposed to sit at the kitchen table too, because they too are expected to fulfill some care duties for their disabled or ill loved one. I’ve heard crazy examples where children are required to do housework because their parent is disabled. I don’t object to chores, but the local government shouldn’t assign them in my opinion.

It is the Community Assistance Act that is worrying me and my husband most in preparation for the possible move. I mean, my health insurance won’t change but my local government will. I trusted the social consultant with the local government in our current town, which happens to be in the same municipality as the institution. That will change if we move to the tiny village, because I’ll stay in my current institution whilst preparing for home support. Not that there is an institution in the tiny village municipality anyway. What this means is, my social worker, my husban and I will have to negotiate with a social consultant who isn’t familiar with my current care situation. Besides, like I said, I trust my current social consultant and you never know who you’ll be stuck with next. Of course, my current social consultant hasn’t made any final decisions yet, so that could be a disappointment too. I E-mailed my social worker asking her to get an idea of care in the municipality we may be moving to. I did a quick read of the municpality website and found out they mention the tiny village in their allocation of social consultants, so I assume this means there must be possibilities.

Ten Things I Like About the Netherlands

One of Mama’s Losin’ It’s writing prompts for this week is to list ten things you like about your state. I tried listing things I like about my province, but it’s proving too hard to write about Gelderland in English. Therefore, I’m cheating a bit and writing about my country as a whole. After all, a U.S. state is often larger than the entire country of the Netherlands.

1. The landscape. This is something I particulalry like in the province of Gelderland. The landscape here consists of woodlands, hills and rivers. In the western part of the Netherlands, many areas below sea level have been man-made. These areas are called polders. I was born practically in the Alexander Polder in Rotterdam, which is the lowest point in the entire country, being six meters below sea level. Most people who are not from the Netherlands like the polders better than the hills and woodlands of Gelderland.

2. The Wadden Islands. I could’ve included them above, but I like them in particular. These are a set of islands north of the mainland. My parents, sister and I would often go on vacation to Vlieland. I loved the dunes and beach of Vlieland, but the island also has some forestry.

3. The politics. No, I dn’t like the Dutch government, since it’s led by a conservative prime minister who gets his way in every area. Labor is on the government too, but they are fake lefties anyway. What I like about the Dutch politics is that small parties like GroenLinks and the Socialist Party can get onto the parliament too. Of course, this does mean that the Christian right gets on the parliament too.

4. The climate. Dutch people tend to think it’s typcal of the Dutch to complain of the weather, but I believe this is a universal way of starting smalltalk. We have a little of all four seasons, though fall always seems to last the longest. I particularly like the springs and summers here and like the occasional day of snow in winter.

5. The values. The Netherlands is considered extremely liberal by American standards. Most people are irreligious and don’t shove their beliefs down your throat. Though I am a Jesus follower and like to participate in American-based Christian culture sometimes, I like to retreat to my little, liberal church too. The Dutch are usually tolerant, though this has gone down a bit since 9/11 and the emergence of first Pim Fortuyn and then Geert Wilders and his Freedom Party.

6. Social security. It’s pretty good here compared to the United States and even most of the rest of Europe. I get around €770 a month. People not in institutions get more, but they substract my long-term care copay. Many benefits are income-based, which is good sometimes for me but not so good at other times because my husband has an income too. However, generally speaking, the Dutch system is mostly egalitarian despite almost fifteen years of right-wing governments so far. I like that.

7. The health care system. The Netherlands maintains a number one position in the European Health Consumer Index, which measures quality of health care systems. Though health insurance was liberalized a bit with the 2006 Health Insurance Act, health insurance is mandatory and usually quite affordable. The government decides what is covered in the basic package, which is the mandatory piece of health insurane, and people can buy additional coverage (with insurers being allowed to refuse them or raise premiums based on pre-existing conditions). The Long-Term Care Act went into effect in 2015 and covers institutional care. For community supports, local governments decide who will be eligible.

8. The educational system. Though we aren’t as much of a knowledge-based economy as the government would like people to believe, education is usually quite good and a lot more affordable than in the United States. College tuition, unless you take longer than usual to graduate, is about €2000 a year. Elementary and secondary education are free until you’re eighteen. We do have a few expensive, private schools, but not nearly as many as other countries do.

9. Music. Though I don’t care for famous Dutch singers such as Frans Bauer or Marco Borsato, I do like music sung in dialects. My parents live in the province of Groningen and I love listening to music from that province.

10. Queen Máxima. No, that’s a joke, but I couldn’t think of anything else. Most people in the Netherlands at least used to adore the queen. She isn’t head of state, as her husband Willem Alexander is, and this probably gives her some extra cuteness.

Mama’s Losin’ It

Racism and Black Peter

Last year, not for the first time but for the first time I did notice, debate sparked in the Netherlands about the St. Nicholas celebration and the color of “Zwarte Piet” (Black Peter), St Nick’s helper. I didn’t pay much attention to the debate, but when a number of my Facebook friends signed the “Pietition” to keep Black Peter black, I did so, too. I had never thought of Black Peter as referring to slavery. Possibly, it’s because I didn’t know that he was decorated rather steretoypcially with red lipstick, earrings, etc. More likely, it’s because I possess White privilege and I horribly neglect racism in my attempts at educating myself about minoriyt points of view.

Around the discussion last year, my husband introduced me to a point of view which said that apparently White people’s enjoyment of the tradition is more important than Black people’s dissatisfaction with it, and this is racist. We, and I include myself here, often say that Black people who complain are just “professional niggers” shouting “racism” at every opportunity to do so. Then again, I for one am pretty well-known for calling out ableism (discrimination of people with disabilities) at every opportunity at least on my blog.

I understand both points of view. White people insisting on tradition probably aren’t otherwise racist, rather more likely having trouble shifting perspective from their own privileged stance to the minority person’s. Of course Black Peter has got to be black, everyone knows this, because I’m in the majority here and I know. On the other hand, Black Peter does have a traditional helper role, which could easily be interpreted as a reference to slavery (and it is likely that the historical St. Nick had slaves too, though they may not have been Black). Tradition is important for many people, but can’t we shift it a little bit for some people’s comfort?

St. Nick will arrive in the Netherlands in Gouda on November 15 this year. The St. Nicholas committee has decided to include a majority of black Peters, but to include yellow-faced “Gouda cheese” Peters too. That way, they give both parties a little of what they want, but I doubt either will be satisfied. Particularly some people supporting traditionally black Peters have radicalized over the year a bit towards a more hostile form of racism rather than mere ignorance.

Mama’s Losin’ It

Talking to Kids About Tragedies in the News

The first news coverage I remember registering consciously, was that surrounding Gulf War I in 1991 and seemingly simultaneously, something about Ukraine – probably the five-year anniversary of the Chernobyl nuclear disaster. I remember, because I thought at the time that Iraq, Iran and Quwait together formed Ukraine. I was five-years-old and didn’t have a clue about tragedies. Maybe I did ask questions, and maybe I was worried, as I often was later on when famine or disease in developing countries was discussed.

I was fifteen when 9/11 took place. I realized by this time that America was far away, so I didn’t feel any sadness or anxiety. Children in America, however, even those not directly impacted, often felt intense sadness and worry. Now a large tragedy didn’t impact my country when I was young – the largest tragedy affecting the Netherlands during my childhood was probably the Bijlmer airplane crash in 1992, which killed 43 people. Children of today, however, have to cope with a tragedy that is almost comparable in size to what 9/11 was for the U.S., ie. the shooting down of Malaysia Airlines flight 17, which was on its way from Amsterdam to Kuala Lumpur last Thursday when it was shot down over eastern Ukraine, killing all 298 passengers and flight personnel, including 193 Dutchpeople. Adults, at least those who’ve not lost family or friends, can put this tragedy into perspective, although with 9/11 in mind, even I am worried for its consequences. Children cannot do this. How do you help children cope with a tragedy like the MH17 crash?

I am focusing here on helping children not directly impacted by a tragedy. If a child has lost a family member or friend in a tragic way, they need extra help coping with the loss of a loved one as well as with the trauma of a tragedy like an accident or shooting. You can, however, reassure children who aren’t directly impacted that they are safe. In a book on coping with trauma I own, adult survivors of trauma are taught that the world isn’t safe, but it won’t get any more or less safe by worrying about it. That is not an effective strategy with non-traumatized children. They need to know that you as the parent, teacher or other adult in their life are there to protect them.

Common Sense Media advises keeping the news away from kids under seven. Preschoolers and Kindergartners are not ready to understand the news and will easily confuse fact with fantasy or fear. My parents had the radio on all the time when I was young, so I registered the Chernobyl and Gulf War news, but made really irrational connections. That being said, the Mayo Clinic recommends that parents do talk about tragedies to their kids, since they’ll likely have picked up on the news somehow anyway.

When kids get older, they start to hear about news tragedies or events from their friends. They still may see news as closer to home or more common than it is, particularly if kids are sensitive. Children between seven and twelve may still make logical errors. For example, a child might worry about their family in Amsterdam because flight MH17 took off there.

At elementary school age, you may start to explain the context of news, especially if your child is intellectually and emotionally mature. You might explain that people have different views and that news programs compete for viewers. You can also start to explain the basics of political or religious conflict. At this point, kids have a strong sense of right and wrong, in the sense that it is all-or-nothing. Therefore, you should be careful not to generalize.

When a child becomes a teen, they will likely start finding the news on their own, without your supervision. Discussing the news with them will give you as the parent a good insight into their developing knowledge and maturity. Common Sense Media says that teens will understand that their lives could’ve been impacted by such tragedies as terrorist attacks. Therefore, it is important to discuss their views and reassure them without dismissing their feelings. They may also want to help people directly affected.

Above all, when talking to a child about a tragedy, the Mayo Clinic recommends telling the truth. Explain the basics and don’t go into too much detail. Avoid speculation on what might be the consequences of the tragedy. Listen carefully to your child for misconceptions, misinformation or underlying fears. Reassure them that you are there for them to keep them safe. If your child asks the same question repeatedly, it’s possible that they just need reassurance.