May 27, 2026 · 7 min read
When the kindest treatment lands as the coldest
Autonomy-promoting policy (autonomiebevorderend beleid, also called hoogrisicobeleid) is a deliberately designed treatment for a very small group, on the order of 0.5 to 3 people per 100,000 residents a year (Michiels et al., 2024), living with complex, chronic suicidality for whom repeated forced crisis admissions can escalate harm rather than contain it. In the summer of 2024 the Dutch patient platform MIND opened a meldpunt about how that policy is carried out and collected 126 reports across 25 institutions, analysed by Bureau Lenz and published 4 December 2024. The reports describe, as lived experience, care that landed as cold, as over-demanding, as confirmation of feeling worthless, and that in cases did not reduce suicidality and was felt to intensify it. This is not how GGZ treats everyone and it is not what therapists do. It is one specific policy, and the people it was built for are the ones who described the cold. The article holds both truths: a treatment can be evidence-reasoned on paper and felt as abandonment in the room.
May 27, 2026 · 6 min read
A therapist may always listen. The wall families hit is a habit wearing a legal costume
A relative calls about a loved one in care and hears "I can't tell you anything, it's confidential." Confidentiality is real, but it is a one-way duty: it governs what a clinician may share with a family, and says nothing about what a clinician may hear from one. The sector's own bodies say so plainly. Ypsilon: much more is permitted than what you often hear in the ggz. The Akwa quality standard treats involving relatives as the recommended norm. Roughly one in six Dutch informal carers now looks after someone with a psychological problem, up from one in eight five years earlier (SCP, 2020), and carers of people with mental-health problems are far likelier to feel heavily overburdened, 34% against 19% for carers overall. The only statutory family advocate exists solely for compulsory care, so the relatives of the voluntary majority have none.
May 27, 2026 · 5 min read
The molecule was probably right. The conversation was missing.
A patient who says they were "drugged into silence" sounds like they are arguing against the medication. The Dutch evidence reads it differently. In primary care, 94.6% of antidepressant use was in line with the NHG guideline (Piek et al., 2011), which forecloses the over-prescription story before it starts. What is documented as the problem sits around the prescription, not inside it: in a 326,025-patient cohort, of those on four or more prescriptions in the first year, 42% were still being prescribed antidepressants in every one of the five years studied (Verhaak et al., 2019), with the authors noting that proactive medication reviews grow sparser the longer the prescription runs; an institute monitoring prescribing found antidepressants used longer than recommended in 40 to 50% of users and called on prescribers to discuss the intended duration at the start (IVM); and a patient panel of more than 750 people found roughly two of three do not co-decide on their own diagnosis and treatment (MIND), against a standard of care that names the patient as the expert on their own experience. The complaint is rarely about the molecule. It is about being prescribed instead of being heard.
May 27, 2026 · 5 min read
The patient is the one person in the room with no vote on their own care
Shared decision-making is a defined, four-step clinical standard (Stiggelbout, 2015; Elwyn, 2017) and a decade-long national project in the Netherlands. The field's own senior researchers concluded in 2022 that the gains are real but uneven, and that the standard has not reached all patients. MIND's established position puts a number on who is left out: more than two in three ggz clients report no clear agreement on their own diagnosis and treatment, and more than 60% were never told a decision needed making. The patient is the one person in the room with no vote on their own care, and the data the field collects on itself says so.
May 27, 2026 · 5 min read
The five-star ghost
On the national client-experience index, the dimension closest to being treated as a person, bejegening en serieus nemen, scores 4.8 out of 5, near the ceiling. But the CQi is filled in after the treatment trajectory ends, so it surveys the finishers. The person who felt like a number and stopped showing up, the one never admitted, is structurally outside the frame. Satisfaction surveys over-represent the satisfied: in one peer-reviewed study only 16.5% responded, and responders differed systematically from those who stayed silent. So 4.8 and niet gehoord, niet gezien are not a contradiction. They are two instruments pointed at two different people.
May 25, 2026 · 6 min read
The signal that tells you if your work is landing is the one you can't see
The therapeutic alliance predicts outcome at r = .278 across 295 studies, the strongest within-therapy signal we have for whether the work is reaching this particular patient. Yet 19.7% of patients leave early, and 93% have lied to their therapist at least once. The rupture in the alliance is detectable in principle, trained observers coding recordings agree on it at ICC .85 to .98, and invisible in the moment, where therapist and patient agree on the bond at only r = .36. The signal of whether your work is landing is the one you can least see while you are doing it.
May 25, 2026 · 6 min read
The therapist who holds everyone in her head
Dutch mental health care held 101,134 waiting spots in October 2025, with the average wait at 24 weeks, and the clinicians already inside carry the overflow. Working memory holds three to five things at once, while a full caseload is twenty or thirty people, each with a history to reload before the hour starts. The cost is not only the therapist's exhaustion. In one study, patients of burned-out therapists reached meaningful improvement 28.3% of the time against 36.8% for the rest, 37% lower odds. The load is invisible, and it reaches the chair across the desk.
May 25, 2026 · 6 min read
The therapist is the last to know the last session was the last
Of 100 people who contact a mental health clinic, fewer than 17 are still in therapy by session 10, and between 20% and 57% who attend a first session never come back for a second. The dropout research suggests therapists often feel the drift but stay silent. 76% sense a client is leaving; only 23% say a word. The patient walks out without a closing session, and the one window for repair shuts before anyone opens it.