Development of guideline programs
Parallel to the introduction of clinical guidelines in mental health care in the US and the UK, the first mental health guideline in the Netherlands was introduced on the topic of Depression in 1994. Many other guidelines were initiated by various professional associations in the following years. In 1998 these professional associations joined together on a national level by starting a ten years multidisciplinary guideline development program, financed by the Ministry of Health. Aim of this program was to produce a set of multidisciplinary mental health guidelines and to prevent further diversification of monodisciplinary documents. In ten years time this collaboration delivered a total of 12 multidisciplinary guidelines for most psychiatric disorders. This period of multidisciplinary guideline development came to an end in 2009 due to the loss of funding. In addition to these multidisciplinary guidelines, the Dutch Psychiatric Association (DPA) also produced 15 monodisciplinary mental health guidelines. In some of these guidelines the DPA worked together with other medical specialties (eg neurology, internal medicine, anaesthesiology).
Increasing health care costs combined with failing economic development changed the political focus during the first decade towards (mostly somatic) chronic diseases. Related to that development new concepts like care programming, disease management and integrated care were introduced. Within these new approaches standards of care were introduced as multidisciplinary documents which described what good care for a specific chronic disease or disorder should minimally include, seen from the patients point of view. These standards of care had to find their societal impact in close collaboration with the clinical guidelines.
In 2010, standards of care were introduced for eg diabetes, heart failure, arthrosis and COPD, and the mental health field produced one such product, a concept standard of care for depression. The value of the different types of knowledge that were used in the standard of care for depression (scientific, expert opinion, patient perspective) was unclear. This was one of the reasons the document was not accepted by the professional organizations.
In 2013 a new nationwide initiative was born, the Dutch Foundation for Quality Development (NKO, now Akwa GGZ*11* The Dutch Foundation for Quality Development (NKO) is now Alliance Quality in mental health care (Akwa GGZ) since January 2019.). The NKO received a budget of 15 million euro’s from the Ministry of Health to develop a large number of practice guidelines for mental disorders in a five year period. The NKO is an initiative by the Dutch society of Psychologists, the DPA and the Dutch Federation of Patient and Family Associations in Mental Healthcare. More than 1000 professionals (representing 80 different associations of professionals), patients, care providers and financers joined forces and have been working together in the development of these standards.