Find the Dutch version of this translation in the hashtag
24 March, 2023 | Author (Dutch version): Mariëtte Baks, science journalist
One of her last duties as director of MIND was to attend the Parliamentary debate on free doctor choice. This is in question, and MIND is concerned about it. ‘Especially in mental health care, it is important that clients have a click with their practitioner. If there is nothing to choose from in this respect in the near future, this could have major adverse consequences. I made an ardent plea for this in the parliament.’ Ter Avest campaigned fanatically until the last minute, and did so for 15 years. With success: partly thanks to MIND, it is now normal for a client’s next of kin to be involved in treatment and for triadic work to be done, she says. Before, that was virgin territory. Now there are family councils, family confidants, family members are increasingly involved in treatment and there is visibility for children.’ The outgoing director calls it a culture change. MIND introduced the family star system, which praises an institution’s family policy.
PROUD
Another thing MIND has fought hard against is the segregation policy. ‘Detention is not care’ is the slogan MIND launched. ‘We wanted to prevent people from being segregated and instead focus on de-escalation. That is now widely accepted in the mental health sector, but we started by putting that issue on the agenda. We brought it firmly into the media and that was well taken up by many psychiatrists and other social workers. It was a kind of awareness-raising.’ Ter Avest, herself dealing with postnatal depression, is also proud of the large demonstration that was staged in no time by MIND – together with the NVvP and NL Mental health Institutions (GGZ) – in 2010 against the plans to make clients in the mental health sector pay a co-payment. Mental health is not a luxury! With 10,000 people on Malieveld: furious we were. And so were the psychiatrists!’ Oh yes, she is also proud of the founding of Together Strong without Stigma, another fine example of cooperation with the NVvP (Dutch Association for Psychiatry). And of Queen Máxima as chair of MIND Us, the foundation that focuses on preventing mental health problems in young people. ‘I got into a conversation with her advisor during a symposium that Queen Máxima attended. That’s how it started rolling and the queen eventually became chair of MIND Us. If, as a society, you want to invest in the well-being of young people, and promote openness and real perceptions about mental problems, what better thing could you have than a queen who is committed to this? She thinks it is very important for young people to be mentally resilient.’
Her last major struggle as director of MIND was against the steering of care contracting as included in the Integral Care Agreement (IZA), which MIND did not sign. ‘Clients will soon be too dependent on where the health insurer buys care. There is no insight whatsoever into insurers’ contracts. We are afraid that clients will soon have no choice at all regarding the right care to avoid waiting lists. The bill will soon be passed on to the client if he or she goes to an independent psychiatrist, and at the same time the independent practices are at risk of collapsing because their care will not be reimbursed. Clients are then forced to rely on the big institutions.’
“Not separation but de-escalation, we put on the agenda“
Self-regulation centres
Over the years, Ter Avest has learned that being angry alone does not help, but that it is important to present alternatives. This approach has ensured that expertise by experience has got hands and feet and is on the map everywhere. ‘There are many mental health institutions that employ experts by experience. That really is a turnaround. Affection and attention to recovery possibilities are aspects that they highlight. Meanwhile, experience expertise is also used outside the mental health sector. There are self-regulation centres where clients can go alongside their treatment or when they are done with it. There, they learn that they are more than their condition. They can attend training courses, talk to fellow sufferers and learn to regain control of their own lives. These services are low-threshold and free. We started with a few such centres; now there are 95. They are an important addition to the ambulantisation of the mental health services, and form a soft and social safety net. Experts by experience understand better than anyone else the impact of an eating disorder, for instance, and how difficult the recovery process can be. They prevent many relapses.
Immense challenges
For the future, Ter Avest hopes that anxiety and sadness will be more open to discussion and that it will be considered normal that things sometimes don’t go so well. MIND draws attention to this with, among others, the MIND Blue Monday Run and the Last Man Standing campaign, playful events that draw attention to mental health in a light-hearted way. We want to show that you are not alone and that it is important to look out for each other. Ter Avest also hopes that psychiatrists and practitioners, who have their feet planted firmly in the clay, will be able to sit at the table during talks on, among other things, the integral care agreement, instead of being represented by the Federation of Medical Specialists. ‘The mental health sector faces immense challenges. Psychiatrists need to discuss current issues, such as how to prevent outflow of mental health professionals, how professionals can work better together around a care question, how to build care networks in the region and how to tackle waiting lists. And also about what I just told you about care contracts and the consequences for freelancers. I also hope that society gains more insight into what the mental health sector does and understands that this care has a crucial place in our society. And that the psychiatrist gets the recognition and professional autonomy befitting a medical specialist, and – again – experiences pleasure in the work.’
Bit guilty
In short, there are still plenty of challenges on the table. ‘Yes, and yet I am leaving… I do feel a bit guilty about it, but my managerial energy has run out a bit due to the enormous dynamics of the sector. I would like MIND to have a new director who can get back to it with fresh energy. My position will be taken over temporarily by Dianne Burger, someone who knows MIND well and has an administrative background in the mental health sector. This temporary solution gives the Supervisory Board time to look for a successor.
Dienke Bos succeeds Marjan ter Avest as director of MIND from 1 June. Bos is originally a neuroscientist and in recent years was executive director of the largest research programme Youth at Untrecht University and the UMC Utrecht.
More about Marjan ter Avest
She was director at MIND from 2016 to 2022. Before that, she was director of the National Support Centre for Client Councils (LSR). Now she is a member of the supervisory board of GGZ Rivierduinen and soon to be director of health fund Duchenne Parent Project.
************************
Autobiographical sketch translator
Peace and Human Rights Activist
Timeline Tilburg OECD violations, 2014 – 2023, bilingual
Tilburg University Code of Conduct and my review on the Code
Who Knows Who Knows Who to Contact?
What is a personality test? What are the effects of discrimination?
Overview translated news items and self-written (some of them published) articles
