7.5 Mental health
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There is no general national strategy addressing the mental health of young people. However, the government declared two focal points in the field of mental health, namely suicide and depression. There are two national government documents to address the mental health of the whole population: a national agenda on suicide prevention (2021-2025) and a multi-annual Depression Prevention Program (2017-now). Both are published by the Ministry of Health, Welfare and Sport (VWS). In addition, positive health and performance pressure among youth are mentioned in the national health policy 2020-2024 as a focal point for the coming years. These three strategies are outlined below.
National agenda suicide prevention
In October 2020 the State Secretary of Health, Welfare and Sport announced the third national agenda on suicide prevention, for the period of 20121 to 2025. It is a general national agenda without specific target groups. The primary aim of the agenda is to slow down the increase in prevalence of suicides and to design actions to achieve that aim. The newest national agenda on suicide prevention elaborates on the goals and activities of the first two national agenda’s. The first national agenda was launched in 2014.
The Ministry of Health, Welfare and Sport has mainly a facilitating role within the national agenda suicide prevention, and partners are responsible for the implementation. The Dutch foundation 113 suicide prevention has a coordinating role in implementing the agenda and monitoring its progress.
The agenda mentions that suicide is the first cause of death among young people between 10 and 25 years. To national agenda contains several goals to better reach youth, for example by improving the safety on social media and by executing the prevention programme Strong Teens & Resilient Minds (STORM) in schools. Also teachers (or members of the care advisory teams at schools) in secondary education should be able to recognize suicidal signals, know how to act and have a good view of the risk groups. Suicide prevention should be a part of the safety policies of educational institutions. Therefore, a suicide policy for schools has to be developed and implemented.
Multi-annual Depression Prevention Programme
At the end of 2016 the Ministry of Health, Welfare and Sport, in cooperation with other stakeholders and partners, presented the multi-annual Depression Prevention Programme. Before the start of this programme, research provided an insight into the 6 risk groups for depression which are also the target groups of this multi-annual programme. Youth are one of the target groups. There are no specific target groups within the youth population.
The programme officially started in February 2017 and runs for at least 5 years. The aim of this multi-annual Depression Prevention Programme is to significantly reduce the incidence and impact of depression, especially in the high risk groups. A decline of 30% by 2030 is (too) ambitious, but it is the goal the Dutch government ultimately wishes to achieve. To do so it is necessary that more people from high risk groups are reached with depression prevention activities.
For the youth target group, the following actions have been defined:
- Awareness: work already started;
- Prevention and early detection: (more) actions are needed;
- Guidance towards (preventive) interventions: (more) actions are needed;
- Training, guidelines and manuals: work already started;
- Innovation and projects by target group: already started, but more actions are needed;
- Support and self-management: more actions are needed;
- Research and monitoring: more actions are needed.
It is not clear if the selection of these actions is based on an evaluation or other research. The Ministry of Health, Welfare and Sport is working on these action points, together with stakeholders and partners, such as client organizations, relevant occupational groups, branch organizations and knowledge institutes. The programme also mentions that addressing the awareness of depression among youth can be done within the healthy school approach (described in paragraph 7.4). Depression fits in the theme ‘wellbeing’ of the healthy school approach. Schools are paying more attention to the absence of pupils at schools, together with youth care professionals and parents/caregivers. In these contacts, underlying problems of absence such as depression can become clear and can be dealt with in an appropriate manner.
GGD GHOR Nederland (the national association of municipal public health organizations), the Trimbos Institute, the Nederlands Centrum Jeugdgezondheid (Dutch Centre for Youth Health Care) and other partners developed the road map Rondom Jong for suicide prevention. The road map helps professionals to improve their cooperation around youth with symptoms of depression.
By 2021, the Ministry and partners will assess whether the programme has sufficient impact and what adjustments or additions are required. The Ministry of Health, Welfare and Sport is responsible for public funding.
Current developments in education and society are regarded to have negative effects on youth’s mental health. The national health policy 2020-2024 mentions that performance pressure, the role of social media and the study loan system may increase the risk for youth to develop psychological problems like depression, sleeping problems and stress. In its national health policy, Government has formulated two ambitions for 2024 to improve youth’s mental health:
- To have knowledge about the nature, size and determinants of young people’s mental health. The National Institute for Public Health and the Environment will streamline research executed by research institutes in order to make research outcomes comparable. The institute will also conduct a large scale quantitative investigation of mental health problems among students in higher education. The Trimbos Institute and GGD GHOR Nederland (the national association of municipal public health organizations) will examine the use of alcohol and drugs in same population group.
- Adolescents and young adults experience less performance pressure in their lives through enhancing mental health skills and stimulating mental health through the physical and social environment. The Ministry of Education, Culture and Science and the Ministry of Health, Welfare and Sport will strengthen each other’s policies. The Trimbos Institute will disseminate knowledge about health skills. On the local level a joint approach by organizations is stimulated, youth’s tenability and resilience are enhanced, pressure among secondary school pupils is lowered and children at risk are offered selective prevention programmes.
Improving the mental health of young people
113 Suicide Prevention
113 Suicide Prevention is the national Dutch suicide prevention center, mainly financed by the Ministry of Health, Welfare and Sport. 113 is targeted at the whole Dutch population, there are no specific target groups within the population. The organization has been active as an independent care provider since September 2009. It employs psychologists and psychiatrists and a large group of fully trained volunteers, which allows 113 to provide round-the-clock confidential support through chats and phone calls. 113 works in close cooperation with the mental health institutes' crisis centers. Together, these professionals are available 24 hours a day, 7 days a week across the Netherlands for crisis talks, psychological treatment or referral to a medical practitioner.
The mental health services of 113 include:
- Crisis chat (a direct opportunity to talk online to a trained volunteer);
- Crisis telephone help line (a direct opportunity to talk to a trained volunteer by phone and, if necessary, to a professional);
- Chat therapy (a maximum of 8 online chat talks with a professional);
- Self-help course (an independent online course aimed at reducing suicidal tendencies);
- Consultation by telephone (the opportunity to pose a brief question to a professional in a session lasting a maximum of ten minutes);
- Self-tests (questionnaires to fill in which offer an indication of the severity of one’s troubles and symptoms (an anxiety and depression test and a test that measures suicidal tendencies);
- Training programmes for professionals about suicide prevention and treatment.
113’s annual report 2018 describes that in 2018 there have been increases in the number of people with suicidal thoughts that were helped by 113. Most of them were helped by chat.
In addition to its mental health services, 113 describes itself as change agent and center of expertise: it leads the National Suicide Prevention Agenda and establishes Suicide Prevention Action NETworks (SUPRANET Care, SUPRANET Community). Activities in these areas include:
- The development and dissemination of training opportunities for medical staff, other professionals and gatekeepers in society;
- Tracking the implementation and sharing of evidence-based suicide intervention best practices within large healthcare institutions, using standardized monitoring instruments and methods;
- Implementation of multilevel multimodal suicide prevention measures in 10 regions, in line with the European Alliance Against Depression (Optimizing Suicide Prevention Interventions OSPI);
- Data-driven quality and safety improvement projects in a network currently numbering 16 mental health hospitals.
113 has also a strong international orientation through participation in the European Alliance Against Suicide and their role in the International Zero Suicide Movement.
113 continuously develops its work by researching the effectiveness and reach of its mental health services together with its partners, namely the VU University of Amsterdam and the mental health institution GGZ inGeest. Together they have initiated SURE-NL (Suicide Research the Netherlands), a scientific consortium aimed at lifesaving suicide research.
Peer learning Participation of young people with mental health issues
This international peer learning project on the participation of young people with mental health issues was an initiative by the Ministry of Health, Welfare and Sport, in response to the Dutch presidency of the Council of the European Union in 2016. During the Dutch presidency of the Council of the European Union, the Netherlands, together with Finland, invited colleagues to participate in European peer learning in the field of young people with psychological problems. About eight countries participated in the peer learning. It was a cross sectoral peer learning with the aim to strengthen the participation of young people with mental health issues. The aims of the peer learning were:
- To share practices and knowledge in the areas of successful youth policy, practice (programmes and interventions) and the active involvement of young people with mental health problems in order to increase successful policy and practices;
- To use the knowledge acquired to increase effectiveness of policymaking and practice in the countries involved;
- To explore the possibilities for increased cooperation between the countries of the peer learning group;
- To disseminate the knowledge acquired amongst EU member states.
The peer learning took place in three multiple day seminars. The first seminar in Amsterdam in 2016 focused on setting the scene for youth work, mental health services and participation of young people, resulting in ‘a mental health informed youth work and a youth involved mental health’. The second seminar in Helsinki in June 2017 focused on education of youth workers and the role of social media. The result was:’ Educating professionals, peers and making the best of what social media has to offer’. The third and last seminar took place in Rotterdam in November 2017. Issues explored were what young people’s needs are and what support they need to be able to stay in school or participate on the labor market, looked at from the perspective of young people with support from youth work and mental health services. All presentations of seminars can be found on the website of The Finnish Association for Mental Health.
The project had a duration of 2 years. The target group of the entire project were youth with mental health issues. The main partners of the third seminar were: the Ministry of Health Welfare and Sport, the Netherlands Youth Institute, the Dutch National Youth Council in cooperation with the Dutch Association of Mental Health and Addiction Care (GGZ NL), Sociaal Werk Nederland, Jongerenwerk Op Zuid (local organization for youth work in Rotterdam) and the participants of the other seminars. It was organized in close cooperation with the Finnish Ministry and the Finnish Association for Mental Health. For the Netherlands, the project was financed by the Ministry of Health, Welfare and Sport.
Strong teens and resilient minds
Given the immense impact of suicide on the environment and the high rates of mood problems among young people, it is extremely important to pay attention to suicide prevention. Therefore GGZ Oost Brabant with various partners in the south of the Netherlands started the Strong and Resilient Teens Minds project (STORM) to pay more attention to these topics. The project focuses on early identification and addressing of depressive complaints among young people in secondary education. This project stimulates the development of resilience and positive self-esteem. The overall aim is to prevent depression and suicide among young people. The STORM project offers multiple interventions for young people.
The STORM-project is mentioned in the multi-annual Depression Prevention Programme as a good practice in preventing depression among young people. The STORM project is a collaboration between GGZ Oost Brabant, GGD, the Trimbos Institute, secondary education schools, municipalities and local partners. Specific information about funding is unknown, but the project is probably funded by local municipalities with public funding.
There is scientific research into the results of the STORM-project. This research took place from 2015 until 2020. The primary objective of the study was to evaluate the (cost) effectiveness of the prevention programme Op Volle Kracht (‘at full strength’) for adolescents with elevated depressive symptoms. This is one of the programmes that can be offered within the STORM project. The secondary objective of the study was to define child related factors associated with the effectiveness of the programme. Participants in the study were selected by screening pupils in the second year of secondary education on depressive symptoms. Pupils with a high suicide risk were referred to specialist care. Pupils with elevated depressive symptoms were invited to participate in an intervention programme of the STORM-project. No results of the STORM-project have been published yet.
Mental health of youth during the corona crisis
During the corona crisis the Ministry of Health, Welfare and Sport launched the Support Center for Corona Concerns (Steunpunt Coronazorgen), an online information and refer center that gives information about mental health during the COVID-19 crisis and a list of care and support providers. A specific page is dedicated to youth with concerns. The page contains advice about how to deal with worrying, designing a daily schedule and staying physically healthy as well as ideas for activities and links to websites with more information, hotlines and self-help apps.
We are also seeing more evidence that the corona pandemic have a big impact on the mental well being of young people. The expectation is that we will see more policies around this during the coming years.