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.