Structures Introducing Disruptive Change to Disability-Focussed Mental Health Care

Jim van Os
Peter Groot
Jim van Os, Maastricht University Medical Centre, Maastricht, The Netherlands - Peter Groot, Maastricht University User Research Centre

In this workshop, we introduce and discuss the implementation of pilots of disruptive change to the mental health care system in the Netherlands, and examine its wider applicability across other countries.

Given evidence that the introduction of recovery oriented practice is difficult to bring about within the disability-oriented discourse of existing mental health structures (eg inconclusive results in REFOCUS[1] and CRIMSON[2, 3] trials in the UK), we developed a blueprint for experimental pilots of disruptive change[4], based on the following principles: small scale, choice, high levels of peer-support and delivery, integrated approach, diagnosis as social construct, social economy, education, activating networks, focus on possibilities and resilience.

To date, 5 pilots in areas no larger than 20.000 population are underway, which will be funded by bed closures and reduction of bureaucracy in the participating mental health organisations. Whilst the initiation of the project has generated much enthusiasm, risk of failure is high, given extensive need for ‘cognitive debiasing’ towards a recovery-oriented discourse, passive resistance and administrative and financial complexities. The aim, nevertheless, is to learn from the experience and disseminate the process and the outcomes.

  1. Slade M, Bird V, Clarke E, Le Boutillier C, McCrone P, Macpherson R, et al. Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. The lancet Psychiatry. 2015;2(6):503-14. Epub 2015/09/12. doi: 10.1016/s2215-0366(15)00086-3. PubMed PMID: 26360446.
  2. Thornicroft G, Farrelly S, Szmukler G, Birchwood M, Waheed W, Flach C, et al. Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet. 2013;381(9878):1634-41. doi: 10.1016/S0140-6736(13)60105-1. PubMed PMID: 23537606.
  3. Henderson C, Farrelly S, Moran P, Borschmann R, Thornicroft G, Birchwood M, et al. Joint crisis planning in mental health care: the challenge of implementation in randomized trials and in routine care. World psychiatry : official journal of the World Psychiatric Association (WPA). 2015;14(3):281-3. doi: 10.1002/wps.20256. PubMed PMID: 26407774; PubMed Central PMCID: PMCPMC4592641.
  4. Delespaul P, Milo M, Boevink W, Van Os J. GOEDE GGZ! Nieuwe concepten, aangepaste taal, verbeterde organisatie. Amsterdam: Diagnosis Uitgevers; 2016.