“It has to be better, otherwise we will get stuck.” A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands

Jim van Os1, 2, *, Floortje Scheepers1, Michael Milo3, Gijs Ockeloen4, Sinan Guloksuz5, 6, Philippe Delespaul5, 7
1 Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
2 Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
3 Milo Health Care Connector and Change Management Consultant, Berlagehof 14, 1067 NB Amsterdam, The Netherlands
4 Reframing Studio Design Introspector, Bilderdijkkade 50 A11053 VN Amsterdam, The Netherlands
5 Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
6 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
7 Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands

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© 2023 Van Os et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University Medical Centre Utrecht, dept. Psychiatry, PO Box 85500, 3508 GA Utrecht, The Netherlands; E-mail:



The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction.


A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required.


A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as and, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation.


By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.

Keywords: Public mental health, Mental health services, Social care, Recovery college, Mental health, Mental health reform, Social trials.