The rights of adolescents to access mental health services : a study on community-based approaches in the mental health care sector of the Netherlands

Abstract

This research analysed in which ways and to what extent the Netherlands uses community-based approaches to ensure the accessibility to mental health services for adolescents and how effective these approaches are in realising adolescents' right to quality mental health services. This study's main objective was to evaluate the positive and negative impacts the use of community-based approaches in the Netherlands on the well-being of the adolescents aged 10 to 18. To achieve the main objective, the study reviewed government policies in the Netherlands on mental health. Furthermore, the study analysed the opportunities and barriers to community-based mental health services for adolescents in the Netherlands to identify policy-level recommendations to improve access to quality mental health services. The study used qualitative research methodology. The collected data came from desk research (secondary sources) and 15 in-depth semi-structured Key Informant Interviews (KIIs) (primary sources). The information identified through primary sources was used to analyse the differences with the information found in the secondary sources. The study was successful in interviewing 8 mental health professionals, 6 youth, 1 NGO professional, and 1 government official/policy maker. The interview participants were divided into four groups; however, the interview's focus for every participant was the same: accessibility to mental health services for adolescents in the Netherlands. Each group had tailored questions since they all had a different contribution to the research. The data were then analysed using a thematic analysis with an inductive approach. The researcher followed the six phases of thematic analysis with an inductive approach indicated by Braun and Clarke (2006). The analysis identifies three main themes: 1) Barriers to accessing mental health services, 2) Barriers to providing mental health services, 3) Opportunities. According to the interviewees, the lack of communication lays at the base of the accessibility barriers. The lack of communication between services and adolescents increases the mistrust in the services, increases the possibility of failed referrals, and allows mental health stigma. The three identified barriers to providing mental health services have one aspect in common: the gap between community-based services and primary health care services. The gap got bigger since the 2015 Youth Law. Community-based professionals feel responsible for adolescents' mental health, and primary health care professionals feel like they are overlooked. The lack of clarity on the government's side and the lack of communication between the services create the gap between community-based services and primary health care services. Lastly, the improvement in communication between all parties and acknowledging adolescents' self-awareness of their mental health could be the opportunities to tackle the barriers to accessing and providing mental health services for adolescents. What can be concluded from the study is that while the Netherlands intended to better the accessibility to mental health services for adolescents by decentralising the care to more community-based services, this is ineffective in realising adolescents’ right to quality mental health services. The results indicate that the lack of communication and clarity on the 2015 Youth Law takes the focus off the main subject: adolescents. On this basis, it is recommended that adolescents should actively participate in all communication levels concerning mental health (services). Furthermore, municipalities are required to raise awareness and increase knowledge of mental health (services) and invest in strengthening community-based providers' expertise on the topic. Schools are recommended to keep having an important role, but the amount of workload will be re-examined. Lastly, the government is required to increase research and implementation of tertiary prevention interventions to help adolescents manage their mental health problems. This study shows that strengthening community-based services is the more appropriate method to reduce accessibility barriers and in turn, target and sustain the quality of mental health support adolescents receive. IMPLICATION OF THESIS Suggestions for future research: 1. Possibilities of implementing self-referrals of adolescents within the Dutch mental health sector. The study should look at examples of the mental health service Jigsaw in Ireland. 2. The effect of COVID-19 on the accessibility to mental health services for adolescents. Future research is needed over a more extended period to analyse differences before, during, and after the global pandemic.