Segregatie of integratie?
The author, formerly faculty member in the Department of Psychiatry in Hannover Medical School in the Federal Republic of Germany, works since 1977 in the field of mental health in the Netherlands as a psychiatrist and as a faculty member in Maastricht Medical School. The article presents an overview and critical reflection of his experiences in this country. In spite of a network of extensive mental health services and a variety of well educated mental health personnel, the Netherlands also have not been able to approximate a more satisfactory system of care for that part of the population that is either chronic or has a very high chronicity risk. Factors to be held responsible are amongst others the tendency of mental health personnel as well as of services to direct their attention and care by preference to those whose needs can be met within a more or less definite chance of success. In mental health personnel this preference occurs on the basis of professionalisation, in mental health services this tendency exists on the basis of particularistic diversification of services and lack of integration. Thus, we are confronted in the Netherlands with two different systems of care, each one having a specific economically bound structure and a specific culturally based approach (philosophy of care). Could they be united in such way that continuity of care for those who need it, shall be guaranteed?