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Background: Coercion in Dutch mental health care has continuously increased since the Special Admissions to Psychiatric Hospitals Act (Bopz) came into force in 1994. With the introduction of the Conditional Authorization in 2004, the increase in involuntary admissions was slowed down and outpatient compulsory treatment increased. The new Compulsory Mental Healthcare Act in the Netherlands (Wvggz) has been in force since 2020 and aims to reduce involuntary admissions., Aim: Description of trends in compulsory mental healthcare based on decisions under the BOPZ and its successors, the Wvggz and the Care and Compulsion Act (Wzd)., Method: Annual data 2003-2023 from the national Council for the Judiciary (Rvdr) on authorizations (legal detentions) were analysed with linear regression., Results: The Rvdr-data show a steady increase of compulsory admissions until 2020. From 2020 onwards, the trend appears to have been halted., Conclusion: The Rvdr data show an interruption of the previously observed increasing trend. The actual number of involuntary admissions unknown due to al lack of a national register.

Background: The Belgian child and adolescent mental health care system is in the process of being substantially reformed and re-shaped., Aim: To outline recent reforms in Belgian child and adolescent mental health care., Method: To provide an overview of the recent literature on service delivery and on the organisation of the Belgian mental health care system for children and adolescents., Results: On the basis of various studies a National Plan for Child and Adolescent Mental Health was drawn up and recently approved., Conclusion: According to this National Plan additional measures will be taken to help children and young people with mental health problems. Networking will play an increasingly important role in the new organisational configuration of the new mental health policy.

Background: Although compulsory admission (CA) is highly relevant to society, epidemiological data for European countries are scarce and of limited reliability and comparability. In several European countries the incidence of CA seems to be increasing., Aim: To estimate the incidence and evolution of CA in Belgium and the Netherlands by pooling and analysing available epidemiological data., Method: We reviewed the literature systematically, paying particular attention to relevant epidemiological data (in published articles and in grey literature). All data were (re)calculated into yearly incidence rates of CA per 100,000 inhabitants., Results: The incidence of CA increased by 42% in Belgium (1999-2008) and by 25% in the Netherlands (2002-2009), culminating in incidence rates of 47/100,000/y (Belgium, 2008) and 80/100.000/y (Netherlands, 2009). Between-country differences can be attributed partly to differences in the legal systems. More detailed results, regional differences, and problems with the comparison of epidemiological data on CA are discussed., Conclusions: Our data point to a significant increase of the incidence of CA in both Belgium and the Netherlands. To improve the comparability and quality of the data on CA, European countries will need to strive for greater uniformity and standardisation in the way these data are registered.

Aim: Because the Dutch population has a growing number of older people, an increasing burden on mental health services is expected. To facilitate policy making for the future, it is important to know what changes there have been in use of mental health services by elderly in the past. This study investigates changes in the use of mental health services by older adults in the period 1990-2004., Methods: Information about the use of mental health services by older adults was retrieved from the Dutch Psychiatric Case Registers. Population size in these register areas and the unit costs of the different mental health services were taken into account., Results: In total there was an increase in the number of older adults that used mental health services in the period mentioned above. The costs, however, showed a decrease, which was caused by the decrease of expensive inpatient care and the increase of less expensive outpatient care. This was mainly the case until 2002. From this year on the ratio between inpatient and outpatient care stabilized., Conclusion: Deinstitutionalization of mental health care for older adults was shown in the period 1990-2002. This means that expensive inpatient care is partly replaced by less expensive outpatient care. As a consequence more older adults can be treated with no rise in costs. Since 2002 deinstitutionalization came to a halt. Because a growing number of older adults will be using mental health services in the future, new forms of outpatient care should be explored.

In recent years there have been significant developments in psychiatry for the elderly in the Netherlands. Epidemiological research has widened its scope, collaborating with other disciplines and thereby creating a range of new perspectives. Patient care is shifting gradually to the general hospital and psychiatry for the elderly has a definite place in the curriculum for trainee psychiatrists. Increasingly, integrated care arrangements are becoming available for elderly psychiatric patients with handicaps. Psychiatry for the elderly has obtained a firm foothold in the Netherlands and should be able to participate in and benefit from the developments that are expected in the years to come.

In the course of the last 50 years our knowledge about the epidemiology, aetiology, pathogenesis, prevention, and treatment of addiction has increased dramatically. Since the 1980s treatment providers have had at their disposal effective psychotherapeutic interventions whereby insightful forms of treatment have been largely replaced by cognitive behavioural therapy aimed at bringing about changes in behaviour. Since the 1990s more and more pharmacological interventions have also been introduced and recently some new neurophysiological interventions have been carefully tested. Finally, considerable progress has been made in assigning patients to the most suitable forms of treatment.

During the past 50 years the border area between psychiatry and somatic medicine has undergone remarkable changes. Theories have become better-founded, both psychologically and neurobiologically, research has become more sophisticated, and liaison-psychiatrists and health psychiatrist/behavioural medicine psychologists have played an increasingly active role in this domain. At the beginning of the 21st century modern psychosomatic medicine is facing new challenges; these include how to create a workable diagnostic classification system, how to instruct and educate both health professionals and lay-persons to an adequate level, how to utilize innovative research paradigms without having recourse to reductionism and how to implement in medical practice treatments that are geared to the needs of the individual patient.

In the past 25 years of forensic psychiatry in the Netherlands, there have been improvements in the quality of information made available for pre-trial assessments, changes in the psychopathological characteristics of the patient population, shifts in the treatment paradigm and an increase in scientific research.

Over the past 25 years the system of centralised management of emergency psychiatry has disappeared and re-appeared. Since 2000 improvements have been made in the logistics, organisation and quality of emergency care. In the same period, however, there has been a horrendous increase in the number of compulsory admissions in the main Dutch cities. The authors hypothesise that this increase may be due partly to organisational changes in the psychiatric emergency services and partly to the introduction of a new mental health act and changes in society.

Background: The advisory document 'Zorg voor Velen '(Care of Many) (2002) calls for the dismantling of the large integrated mental healthcare institutions in the Netherlands. The minister of Health has taken the advice contained in that document, thus bringing to an end a period of thirty years when policy was directed towards more cohesion in the mental healthcare services. The reactions to this change in policy vary tremendously., Aim: To describe developments within the mental healthcare system and to interpret the advice that was offered and the reactions to it., Method: A historical analysis of the Dutch mental healthcare service since 1970 and an interpretation of the indicators and policy choices., Results: The Dutch mental healthcare service has developed into one large healthcare sector and as a result many institutions have been forced to merge. At the same time the number of patients in this sector has increased dramatically, whereas the number of psychiatric patients in primary care has decreased. Meanwhile, care has moved in the directions of medically specialised care, partly because tasks and responsibilities have been transferred from one discipline to another., Conclusions: The movement towards one large single integrated care sector has led to the categorisation of care for the mentally ill and has increased the number of patients in the mental healthcare sector. Treatment has become more medicalised and specialised. As a result the mental healthcare system has found itself in an intolerable situation. The situation can only be resolved if a much sharper distinction is made between general primary care and specialised secondary care and ifsteps are taken to forge links with general health care.

Since a population-based registry of the mentally retarded is lacking in The Netherlands, data concerning incidence and life expectancy patients with Down's syndrome (DS) are not available. Based on birth statistics, in combination with risk factors for DS in relation to maternal age on the one hand and on studies on life expectancy in DS from Denmark, British Columbia and Western Australia on the other, the numbers of these patients older than 40 years were estimated for The Netherlands for the period 1990-2025. After a considerable increase of the number of institutionalized DS patients of 40 years and older between 1958 and 1985, the present estimates indicate a further rise. It is expected that the level of aged DS patients will be highest between 2005 and 2020, and will increase at least to numbers 50% above those expected for 1990. These findings have to have an impact on the capacity planning for institutes for the mentally retarded.