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Undergraduate and graduate students from the Social Work Department, the Counseling Department, and related departments were introduced to the differences in which mental health services are provided within a socialized welfare system, where healthcare is managed by the government, as compared to that which exists in the United States, where health care is typically the responsibility of private organizations. Students had the opportunity to actively engage in discussions with mental health service providers, as well as clients in recovery in various cities across the Netherlands. These cities include Haarlem, Utrecht, Eindhoven, and Amsterdam. Although the main focus of this study tour was mental health care, other topics included dual diagnosis, chemical dependency, and working with clients with criminal histories.

On the morning of January 9th, Dr. Pulice, Chair of the Social Work Department and Director of the Institute for Community Research and Training, presented a lecture on the historical background of mental health services in the United States at HAN University of Applied Sciences, Nijmegen. Linda Broos was our host. HAN University of Applied Sciences seeks to provide high quality education that is relevant and practical to the field. HAN University of Applied Sciences’ utmost responsibility is to contribute to the development of society. Find out more about HAN’s mission and core values. The attendees included Saint Rose students, students of HAN University, as well as professionals in the field. That same afternoon, Johan Manders, Coach at GGz Breburg, and Manager at VOF Dubbel Diagnosis for GGz Breburg, hosted a tour of a Mental Health/ Dual Diagnosis Program Breberg in Tilburg (referred to as co-occuring disorders in the United States). Following lunch, Linda presented her program. Following Linda’s presentation, we were given the option of shadowing one of the service providers to a group session, or visiting the homes of patients. Visiting the clients in their homes was an interesting experience for all of us. The supportive environment placed in order by the service providers appeared to be more relaxed, less institutionalized in appearance, and allowed for more consumer education and freedom. The supported living environments (designed to allow people to live as independently as possible) and living institutions placed more of a focus on the environment and it’s impact on mental health than the United States; making the environment as close to a home-setting as possible appeared to be a primary focus. Lastly, we were invited to a delicious, home prepared meal by a consumer, and casual dinner conversation. The clients were all given domestic responsibilities, and their responsibilities varied some days. Most clients appeared to be content to be a part of the system.

On January 10th, each student visited outreach teams throughout the Netherlands. Many students shadowed home visits to consumers with service providers on bicycle. It is important to note that many service providers were at some point in their lives struggling with mental health issues, chemical dependency, and other issues, and were first introduced to the mental healthcare system as consumers. A wonderful learning experience, students got to meet with consumers on a personal level, with some consumers willing to disclose personal stories about their experiences in a socialized welfare setting of health care, as compared to their experiences in the former model of institutionalized care, similar to that of the United States. Clients expressed genuine satisfaction with the change in the delivery of their treatment and services, and expressed it as a more positive, humane, person-centered approach to recovery. Public housing varied from very impressive to not-as-impressive, however, many consumers were allowed to have their own residences. Another notable mention is regarding responsibility of service providers. If a consumer was found to be engaged in illegal activity, it is not the service providers responsibility to convene, but that of the police, as it allows for the client-counselor relationship to be less intimidating for the client, and helps to build trust in the counselor. Many clients disclosed that they had engaged in illegal activity without any apparent fear of being reprimanded.

On January 11th, the group visited Mental Health Beilen, with Rokus Loopik, and Wijnand Mulder, psychiatrist and medical director at a long stay hospital for homeless, double-diagnosed people with a history of several forced admissions in psychiatric institutions, detention for shoplifting, misdemeanors, and street crime. In addition to learning about the ways in which the mental healthcare system has changed in the Netherlands, students were able to casually chat with some of the consumers, after which, many of the consumers put on a skilled musical performance. The students were given a tour of the facilities, which comprised different shops, as well as a private community with individuals living in their own apartments, work opportunities, and a relaxation room. Although these clients had been involved with crime in the past, they are allowed to leave the premises as long as they have earned the right to do so. Again, personal freedom seemed to be of much importance to the agency.

On January 12th, the students were provided with a tour of GGZe Eindhoven, a large regional mental health service provider, where Tomas Goebbels was our host. Here, we learned of the different facilities that serviced individuals with varying mental health disorders. There was an arts and crafts room and many other activities to choose from. Individuals with Mental Retardation were also served at this facility. These consumers were given their own rooms and roamed freely around their ward. It is important to note that all of these consumers were high-functioning. A great dependency of staff to medicate these individuals with a bountiful supply of medications is different from the United States’ tendency to reduce reliance on medication, except when necessary.

On January 13th, Rokus Loopik once again joined us with two of his clients for a discussion on their opinion of recovery, treatment according to the old model, and treatment according to the new model. Both clients appeared to have showed great improvements in their recovery, were doing well, and were appreciative of the services they received. Many consumers in this model go on to become service providers, and are offered assistance to acquire the necessary education to do so. Although the clients appeared to be asymptomatic, regardless of their diagnosis, they seemed to have a firmer grasp of the epidemiology of their illnesses, and great determination to have a life separate from their disorders.

Copyright 2012 | The Institute for Community Research and Training | The College of Saint Rose