Treatment of mental disorder in the primary care setting in the Netherlands in the light of the new reimbursement system: a challenge?
BACKGROUND
Different professionals provide health care for mental disorder in the primary care setting. In view of the changing reimbursement system in the Netherlands, information is needed on their specific expertise.


METHODS
This study attempts to describe this by literature study, by assessment of expert opinions, and by consulting Associations of the relevant professions.


RESULTS
There is no clear differentiation of expertise and tasks amongst these professionals in primary care. Notably, distinction between different psychotherapeutic treatment modes provided by psychologists is unclear.


CONCLUSIONS
Research is needed to assess actual treatment modules in correlation with patient diagnostic classification for the different professions in primary care. An alternative way of classifying patients, that takes into account not only mental disorder or problems but especially the level of functioning, is proposed to discern which patients can be treated in primary care, and which patients should not. Integrated care models are promising, because many professionals can be involved in treatment of mental disorder in the primary care setting; especially for collaborative care models, evidence favours the treatment of common mental disorders in this setting.


CONCLUSIONS
Integrated care models, such as collaborative care, provide a basis for multidisciplinary care for mental disorder in the primary care setting. Professional responsibilities should be clearly differentiated in order to facilitate integrated care. The level of functioning of patients with mental disorder can be used as indication criterion for treatment in the primary care setting or in Mental Health Institutions. Research to establish the feasibility of this model is needed.
van der Feltz-Cornelis
Christina M
CM
Head of Program for Diagnosis and Treatment of Common Mental Disorders, Trimbos Institute, NIMHA/Trimbos Instituut, PO Box 725, 3500 AS, Utrecht, The Netherlands, and Senior Researcher, EMGO Institute, VU Medical Centre, Amsterdam, The Netherlands.
Knispel
Aafje
A
Elfeddali
Iman
I