Introduction
Improving quality of care by using clinical guidelines based on well graded research evidence has been the standard in the Netherlands for the past 25 years, also in mental health care. In these years we have gradually improved our knowledge about how to evaluate health and health care related scientific results. By trial and error we learned how to meta-analyse and integrate ever increasing amounts of scientific findings into applicable scientific knowledge. We also discovered how to develop, publish and disseminate clinical guidelines and how to educate professionals in using guidelines as tools for the implementation of new clinical practices. Comparing the training of mental health professionals today with that of the pre millennial nineties shows a tremendous paradigm shift from opinion expert based clinical thinking and practicing towards structured, protocoled, multidimensional, evidence based practice.
However, after this first promising early age a possibly too strict and consistent utilization of evidence based medicine more recently begins to show some of its drawbacks and possible disadvantages more clearly. Questions about the further progress from ‘one disorder’ guidelines towards guidelines for complex and comorbid health conditions1,2, the appraisal and integrated use of more diverse types of knowledge (observational, expert, experiential)3, about the financial consequences of implementing guidelines for health care costs, about the real effectiveness of guideline implementation for changing provider performance and/or patient outcomes4, and about the principles for updating of guidelines5 threaten a productive further progress.
Different countries have shown different evidence based practices and guideline histories and are trying to find cultural sensitive solutions for the above named questions. In this paper we will describe the development and current situation in Dutch mental health care. We aim to consider three aspects: We first give information about the different guideline programs that were developed over the past two decades; what steps have been taken, how did we organize this, what was the output, and what were the limitations. Second, we will elaborate on this development in more detail and focus on the past five years during which we executed a nationwide program to produce a set of practice guidelines (standards of care and generic standards). The program was commissioned by the Dutch Foundation for Quality Development (NKO). We describe how and by whom NKO was created and how this program resulted in a set of quality standards. Third, we want to describe an example (the standard of care for depression) to give more detail about the way we have been working. We value sharing our experiences with practice guidelines program for mental health care and hope it will be inspiring for other countries.