Organisatie van geestelijke gezondheidszorg voor mensen met een ernstige en persisterende mentale aandoening

1 INTRODUCTION AND RESEARCH QUESTIONS 5 -- 2 GENERAL BACKGROUND: DEFINITIONS AND SCOPE OF THE STUDY 7 -- 2.1 CHRONIC AND COMPLEX MENTAL DISORDERS: DEFINITIONS AND SCOPE OF THE -- STUDY 7 -- 2.1.1 Definition: Mental disorder 7 -- 2.1.2 Definition: “Chronic” or “severe and persistent” mental disorders 8 -- 2.1.3 Additional limitations of the scope of this study 8 -- 2.2 ORGANISATIONAL FORMS OF PSYCHIATRIC CARE: DEFINITIONS AND SCOPE OF THE -- STUDY 9 -- 2.2.1 Introduction 9 -- 2.2.2 Definition: Mental health service 9 -- 2.2.3 Typology of mental health services 9 -- 2.2.4 Additional limitations of the scope of this study 12 -- 2.3 OUTCOME EVALUATION: GENERAL PERSPECTIVE 12 -- 2.4 EVIDENCE-BASED HEALTH SERVICES RESEARCH AND HEALTH CARE POLICY 13 -- 3 LITERATURE REVIEW: METHODOLOGY 18 -- 3.1 INTRODUCTION 18 -- 3.1.1 European Service Mapping Schedule (ESMS) 18 -- 3.1.2 Types of study to be included 18 -- 3.2 SEARCH STRATEGY, IN- AND EXCLUSIONCRITERIA 18 -- 3.2.1 Cochrane Database of Systematic Reviews and CRD Database (CRD-reports, DARE, -- HTA) 18 -- 3.2.2 Medline (Ovid), PsycInfo, Embase. 19 -- 4 LITERATURE REVIEW: RESULTS 21 -- 4.1 DEFINITIONS 21 -- 4.2 MENTAL HEALTH SERVICES, RESIDENTIAL, NON-HOSPITAL 28 -- 4.2.1 Mental Health Services, Residential, Acute, Non-hospital. 28 -- 4.2.2 Mental Health Services, Residential, Non-acute, Non-hospital, Indefinite stay (Daily -- support, 24h-support, Lower than daily support). 29 -- 4.2.3 Mental Health Services, Residential, Non-acute, Non-hospital, Time limited stay. 32 -- 4.3 MENTAL HEALTH SERVICES, OUT-PATIENT AND COMMUNITY 33 -- 4.3.1 Mental Health Services, Out-patient and community, Emergency care (mobile/ nonmobile). -- . 33 -- 4.3.2 Mental Health Services, Out-patient and community, Continuing care. 35 -- 4.4 MENTAL HEALTH SERVICES, DAY & STRUCTURED ACTIVITY 46 -- 4.4.1 Mental Health Services, Day & structured activity, Acute. 47 -- 4.4.2 Mental Health Services, Day & structured activity, Non-acute, Work or work-related -- activity (high & low intensity). 49 -- 4.4.3 Mental Health Services, Day & structured activity, Non-acute, Other structured activity, -- (high & low intensity). 51 -- 4.4.4 Mental Health Services, Day & structured activity, Non-acute, Social support, (high & -- low intensity). 52 -- 4.5 CONTINUITY OF CARE, SERVICES & SYSTEMS INTEGRATION, CARE PROGRAMS 52 -- 4.5.1 Continuity of care 52 -- 4.5.2 Services and systems integration 54 -- 4.5.3 Care programs, Care pathways. 60 -- 5 LITERATURE REVIEW: CONCLUSIONS 61 -- 5.1 DIAGNOSIS OF “CHRONIC AND COMPLEX” OR “SEVERE AND PERSISTENT” MENTAL -- ILLNESS. 61 -- 5.1.1 Definition of “severe and persistent” mental disorders 61 -- 5.1.2 Prevalence of severe and persistent mental disorders 62 -- 5.2 LITERATURE EVIDENCE ON ORGANIZATION OF MENTAL HEALTH CARE 63 -- 5.2.1 Methodological reflections 63 -- 5.2.2 Which mental health care services to organize for SMI persons? 64 -- 5.2.3 Integrated care, Continuity of care, Care pathways and Networks of care for SMI -- persons: the evidence. 67 -- 5.3 LIMITATIONS OF THE LITERATURE REVIEW 70 -- 6 INTRODUCTION INTERNATIONAL OVERVIEW 72 -- 6.1 SCOPE OF THIS SECTION 72 -- 6.2 SELECTION OF THE COUNTRIES 72 -- 6.3 GENERAL METHODOLOGY 73 -- 7 BELGIUM 74 -- 7.1 LITERATURE SEARCH: METHODOLOGY 74 -- 7.2 GENERAL ORGANIZATION OF THE BELGIAN HEALTH CARE SECTOR 74 -- 7.3 GENERAL FINANCING OF THE BELGIAN HEALTH CARE SECTOR 75 -- 7.3.1 General principles 75 -- 7.3.2 The statutory insurance system 75 -- 7.3.3 The complementary insurance system 76 -- 7.3.4 The private system 76 -- 7.4 GENERAL ORGANIZATION AND FINANCING OF SUPPORT SERVICES FOR PEOPLE -- WITH DISABILITIES 76 -- 7.5 ORGANIZATION OF THE MENTAL HEALTH CARE IN BELGIUM 76 -- 7.5.1 Historical context 77 -- 7.5.2 Third reformation wave: care circuits and networks of care 78 -- 7.5.3 Data collection, scientific institutes 83 -- 7.5.4 Mapping of existing services 83 -- 7.5.5 The ‘Mental health care tree’ in Belgium 85 -- 7.6 FINANCING OF THE MENTAL HEALTH CARE SECTOR 95 -- 7.6.1 Global data 95 -- 7.6.2 Approach per sector of activities 95 -- 7.7 SPECIFIC PROBLEMS OF THE BELGIAN MENTAL HEALTH ORGANIZATION 96 -- 8 FRANCE 98 -- 8.1 LITERATURE SEARCH: METHODOLOGY 98 -- 8.2 ORGANIZATION AND FINANCING OF THE HEALTH CARE SECTOR: SOME ASPECTS 98 -- 8.2.1 The statutory insurance system 98 -- 8.2.2 The complementary insurance system 99 -- 8.2.3 The financing of the hospital sector 99 -- 8.2.4 The French health care system: which problems?. 100 -- 8.2.5 Impact of quality assessment in the French health care system. 100 -- 8.3 THE MEDICAL SOCIAL SECTOR IN FRANCE 101 -- 8.4 ORGANIZATION OF THE MENTAL HEALTH CARE SECTOR IN FRANCE 102 -- 8.4.1 Historical background 102 -- 8.4.2 General principles – the sectorization 103 -- 8.4.3 Evolution of the French policy from 2003 onwards 105 -- 8.4.4 Mapping of existing services: Introduction 108 -- 8.4.5 The ‘Mental health care tree’ in France 111 -- 8.5 FINANCING OF THE MENTAL HEALTH CARE SECTOR 119 -- 8.5.1 Global data 119 -- 8.5.2 Data per sector of activities 119 -- 8.5.3 Key issues on financing of psychiatric care 121 -- 8.6 THE FRENCH MENTAL HEALTH CARE ORGANIZATION: DISCUSSION 122 -- 9 THE NETHERLANDS 123 -- 9.1 LITERATURE SEARCH: METHODOLOGY 123 -- 9.2 GENERAL HEALTH CARE ORGANISATION 123 -- 9.2.1 History 123 -- 9.2.2 Recent changes 123 -- 9.3 GENERAL FINANCING OF HEALTH CARE 125 -- 9.4 MENTAL HEALTH CARE ORGANISATION 126 -- 9.4.1 History 126 -- 9.4.2 Specific programmes: care programs and care circuits 126 -- 9.4.3 Most recent changes 127 -- 9.4.4 Scientific institutes, Knowledge centers for mental disorders 128 -- 9.4.5 Mapping of existing services 128 -- 9.5 FINANCING OF MENTAL HEALTH CARE 133 -- 9.5.1 Global data 133 -- 9.5.2 Data per sector of activities 133 -- 9.6 ADVANTAGES/DISADVANTAGES OF THE DUTCH MENTAL HEALTH CARE -- ORGANIZATION 135 -- 10 SPAIN 137 -- 10.1 LITERATURE SEARCH: METHODOLOGY 137 -- 10.2 ORGANIZATION AND FINANCING OF THE HEALTH CARE SECTOR 137 -- 10.2.1 Organizational overview of the health care system 137 -- 10.2.2 Financing of the health care sector. 138 -- 10.3 ORGANIZATION OF THE MENTAL HEALTH CARE IN SPAIN 139 -- 10.3.1 The ‘psychiatric reform’ 139 -- 10.3.2 General principles 140 -- 10.3.3 Mental health indicators: heterogeneity between Autonomous Communities 142 -- 10.3.4 Social services for people with disability or dependence 142 -- 10.3.5 Mapping of existing services 143 -- 10.3.6 The ‘Mental health care tree’ in Spain 144 -- 10.4 FINANCING OF THE MENTAL HEALTH CARE SECTOR 147 -- 10.4.1 Global data 147 -- 10.4.2 Approach per sector of activities 147 -- 11 DENMARK 150 -- 11.1 LITERATURE SEARCH: METHODOLOGY 150 -- 11.2 GENERAL ORGANISATION OF HEALTH CARE 150 -- 11.2.1 Recent important health care policy changes 150 -- 11.2.2 The policy-levels in health care 151 -- 11.2.3 Organisation of the Danish health care sector 152 -- 11.2.4 Funding in general terms 153 -- 11.3 MENTAL HEALTH SERVICES ORGANISATION 153 -- 11.3.1 Mental health care reforms 153 -- 11.3.2 Mental health care organisation: the ‘Mental health care tree’ in Denmark 155 -- 11.4 FINANCING OF THE HEALTH CARE SECTOR 157 -- 11.4.1 Global data 157 -- 11.4.2 Approach per sector of activities 158 -- 11.4.3 Financing of the mental health care sector 158 -- 12 ENGLAND 159 -- 12.1 LITERATURE SEARCH: METHODOLOGY 159 -- 12.2 GENERAL ORGANISATION OF HEALTH CARE IN ENGLAND 159 -- 12.3 GENERAL FINANCING PRINCIPLES OF HEALTH CARE 160 -- 12.4 ORGANISATION OF MENTAL HEALTH CARE: 161 -- 12.4.1 Policy reforms in the organisation of mental health care 161 -- 12.4.2 National institute for mental health 163 -- 12.4.3 A review of community mental health services 163 -- 12.5 DESCRIPTIVE CHARACTERISTICS OF MENTAL HEALTH SERVICES 165 -- 12.5.1 Preliminary comments 165 -- 12.5.2 Mental health care trusts and primary care trusts 166 -- 12.5.3 Residential mental health services 167 -- 12.6 FUNDING OF MENTAL HEALTH CARE 172 -- 13 AUSTRALIA 173 -- 13.1 LITERATURE SEARCH: METHODOLOGY 173 -- 13.2 ORGANISATION AND FINANCING OF THE HEALTH CARE SECTOR 173 -- 13.2.1 Organization of the Australian health care system 173 -- 13.2.2 Financing principles of health care 173 -- 13.2.3 Support services for people with disabilities 174 -- 13.3 ORGANISATION OF THE MENTAL HEALTH CARE IN AUSTRALIA 175 -- 13.3.1 General organisation of the mental health care 175 -- 13.3.2 Recent reforms 175 -- 13.3.3 Mapping of the existing services: introduction 181 -- 13.3.4 The mental health tree in Australia 182 -- 13.4 FINANCING OF THE MENTAL HEALTH CARE SECTOR 187 -- 13.5 DISCUSSION AND CONCLUSION 188 -- 13.5.1 The National Mental Health Strategy and its evaluation 188 -- 13.5.2 Results of the reform process 190 -- 14 INTERNATIONAL OVERVIEW: CONCLUSIONS 192 -- 14.1.1 Deinstitutionalization: where are we now? 192 -- 14.1.2 The balanced care model 193 -- 14.1.3 Organization of contemporary mental health care. 194 -- 14.1.4 Care organization: integrated care, continuity of care, care programs and networks of -- care 195 -- 14.1.5 Evaluation of quality of care, Performance indicators 198 -- 14.1.6 International overview 199 -- 14.2 OVERALL CONCLUSION KEY POINTS 209 -- 15 REFERENCES 211