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The writer of this paper recently visited Holland for a study tour in January 2012.  This paper is a reflection of this writer’s thoughts regarding the Dutch and United States mental health care systems.  This paper will discuss how other courses this semester have been influenced by participation in this study tour.  Lastly, this paper will discuss how participation in this course might influence this writer’s future practice.

How Participating in a Study Tour to Holland has Influenced Other Courses This Semester

Utilizing a Collaborative Approach

This writer interns at Rehab Support Services (RSS), and has taken note of the integration of professionals from different fields.  This is a result of discussing collaboration in Holland and bringing to this writer’s attention the limitations of not having a collaborative and multidisciplinary approach to mental health care.  RSS team meetings are held at the start of each work day.  Interns, management, social workers, peer support specialists, a psychiatrist, nurses, mental health counselors, and direct care staff assigned to apartment programs are among the helping professionals that discuss consumer care together, offering information in their selected area of expertise.  This is most often beneficial.  For example, a social worker may be stuck with a consumer.  That social worker will report his or her concerns during the next meeting and receive input from medical specialists, counseling specialists, and other professionals adept at working with people with mental illness.  This process of collaboration fosters a sense of community within the organization, and allows for varied and more effective solutions to dilemmas.

In Holland, there is not a focus on collaboration with outside organizations and providers of mental health services like in the United States (Van Os, Hilwig, & Delespaul, 2004).  Collaboration with outside providers is a significant strength of the mental health care system in the United States.  As a result, more treatment options are available for consumers.

Problems for People Without Insurance in the United States

Unlike in the United States, consumers in Holland do not require prior approval from their primary care physicians.  This increases access to specialized care (Lepolstat et al. (2009).  At RSS, this writer has encountered that consumers often have difficulty following through with doctor appointments.  The requirement of a referral from a primary care doctor slows down the process of receiving medical attention from an appropriate service provider.  As a result, consumers often have to wait long periods of time before they get an appointment with an appropriate specialist, increasing the likelihood of their condition worsening and experiencing worsening or a relapse in mental health symptoms.

Health Care Plans That Limit Treatment Options

Medicaid is the primary health insurance option utilized by consumers at RSS.  Consumers are approved for specialized therapeutic services, as defined by their treatment plan.  Often times, this writer has felt the need to utilize a service, for example, coping skills training, but later discovers when recording progress notes that it is not an approved service for that individual.  This results in this writer having to reframe the definition of the service so that it fits a service that Medicaid will cover (despite the fact that the consumer may need a service not specified in his or her treatment plan).  If the service provided does not fit any approved billing description, Medicaid does not provide payment.  Health care plans that limit treatment options result in fewer effective and appropriate treatments for both American and Dutch consumers (Van Os, Hilwig, & Delespaul, 2004).

How This Experience Might Influence This Writer’s Future Practice

After experiencing the Dutch mental health care system, this writer feels that health plans should not require prior doctor authorization for a referral in the United States, and will advocate for increased accessibility to specialists without the need for a referral.  This writer feels that a multidisciplinary, collaborative approach to mental health care, like in the United States, is vital to delivering the best services possible, and as a result, this writer feels that not taking such an approach would be unethical.  This writer also feels that health care plans should not be allowed to limit treatment options, and that such an approach to consumer care is contradictory to the current trend of person-centeredness.

This writer feels that a consumer should be permitted to choose which services he or she receives, based on what they feel they need assistance with, with the exception of mandated services that they must participate in to avoid being in criminal custody.  This writer would like to see more choices for consumers in regards to treatment options, and hopes that consumers will one day have more control over their mental health care.

Conclusion

The author of this paper feels that her experience in Holland has influenced her future practice as it has brought attention to the differences between the United States and Dutch mental health care systems.  This writer favors a collaborative, multidisciplinary approach, more common in the United States.  In the United States, consumers require preliminary authorization from their primary care physician, which increases access to specialized care, unlike in the Netherlands, where prior authorization from a physician is not required (Lepolstat et al. 2009).  This writer feels health care plans that limit treatment options, like Medicaid, are unnecessary, and both slows down treatment and increases cost.

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