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 if steps are taken to forge links with general health care.