title: Breakdown of continuity in public mental healthcare in the Netherlands: a longitudinal case study.
abstract: BACKGROUND
  Continuity of care for long-term service-dependent patients in the public mental health system requires intensive collaboration between all agencies involved. Understanding the ways in which various aspects of continuity of care interact may reveal help to find out more about how care delivered over time improves outcomes.
  
  
  METHODS
  Based on medical records, an addicted couple was monitored for number and type of contacts with health and social services. Over the years, 81 social workers or nurses, spread over 25 health and social services, have been involved in the rehabilitation process. Breakdown of continuity of care is linked to lack of information, missing procedures and guidelines, fragile relationships with the patient, and a reluctant public health approach.
  
  
  CONCLUSIONS
  Prominent among relevant factors is the absence of protocols governing the transfer of patients between the various links in the continuum of mental healthcare services. High-quality follow-up after admission is partly a matter of professional principle in ensuring that problems in the chain of services are discussed. Case presentation in psychiatric journals should give systematic attention to sources of error in continuity of mental healthcare.
authors: Department of Psychiatry Erasmus MC, O3 Research Centre Mental Healthcare Rijnmond, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors: André I
authors: AI
authors: Wierdsma
authors: Meta
authors: M
authors: van der Schee
authors: Cornelis L
authors: CL
authors: Mulder