Deinstitutionalization: The Dutch way?

Inspired mainly by the example of Italian ‘Democratic psychiatry’, around the mid-nineteen eighties, the policies of both Dutch government and the field of mental health care turned towards the aim of deinstitutionalization. Official governmental directives included the gradual dismantling of some of the larger mental hospitals, the increase of the number of sheltered homes, and the introduction of e.g. assertive community treatment and rehabilitation. These contributed to a shift towards community psychiatry during the nineties. Nevertheless, at the beginning of the 21st century, the Netherlands figured amongst the European countries with the highest number of institutional beds. The reasons for the ‘lagging behind’ or the different pathway of Dutch mental health care are still a matter of discussion and a subject for historical research. Some possible causes can already be hypothesized. Around 1970 Dutch institutional mental health consisted of medium-sized psychiatric hospitals with comparatively high standards of care. Starting during the 1920s, the Netherlands had a pioneering role in the development of a nationwide system of community psychiatry, which probably resulted in a situation in which the pioneer is lagging behind once all the others followed. Furthermore, parallel and interfering developments in society and government policies during the last decades of the 20th century – e.g. the demise of the welfare state and the liberalization of health insurance – had a negative effect on the reorganization of mental health care. In this paper the development of deinstitutionalization in the Netherlands will be analyzed against the background of the international historiography on this subject, aiming both at the distinction of different (national) models and phases in the history of the transfer of psychiatric care to the community.