Do multidisciplinary guidelines improve the quality of regional mental health care for people with schizophrenia in the Netherlands?

Background/Objectives: People with schizophrenia experience serious health problems, social disadvantages, and unmet needs in multiple life domains. They need access to high-quality treatment in the community, enabling them to go through life as valued citizens. This requires a comprehensive care system on a regional scale, which is transparent for patients to understand its potential benefits for their recovery. Patients, their families, and clinicians, each have their own views on the identification of needs, and the prioritization of services. From a professional point of view, a service system should consist of evidence-based practices, such as Assertive Community Treatment (ACT), and state-of-the-art pharmacotherapy. In reality however, many patients are confronted with inadequate services. This study reports on the strengths and weaknesses of regional mental health care systems for people with schizophrenia as assessed by the Quality Assessment of Regional Treatment Systems for Schizophrenia (QUARTS). A follow-up was conducted in eight regions in the Netherlands to investigate whether the introduction of multidisciplinary guidelines improves the quality of regional mental health care service systems.

Methods: The QUARTS, a standardised interview instrument with more than 100 questions about 25 aspects of care, was developed by a taskforce and reflects the international state of knowledge regarding treatment and rehabilitation services for people with schizophrenia. It contains two parts: one about the availability of services and one about their evaluation based on the perspectives of stakeholders such as clinicians, patients, families, and community organizations. Two assessments were made, the first about the time of the introduction of the schizophrenia guidelines (2005), and the second two to four years later.

Results: The baseline assessment demonstrated a large gap between theory and practice but the follow-up showed clear progress in the availability and evaluation of various aspects of care in all regions, such as the implementation of ACT. However, evidence-based rehabilitation interventions were hardly implemented.

Discussion/Conclusions: The multidisciplinary guidelines for schizophrenia appeared to be an important factor in the implementation of evidence-based interventions in the Netherlands, despite the lack of incentives from the government or other financial bodies. QUARTS can be a helpful instrument for the monitoring and development of services, leading to a higher quality of routine mental health practice, and to a reduction of inter-regional differences. Nevertheless, Dutch schizophrenia care is still patchy. In particular, support for patients’ desires for social inclusion is limited.

Funding: Netherlands Organisation for Health Research and Development (ZonMw, grant no. 100–003–021), De Open Ankh, and by the following mental health organisations: GGZ Delfland, GGZ Drenthe, GGZ Dijk en Duin, GGZ Noord-Holland Noord, GGZ Noord- en Midden-Limburg, InGeest, Rivierduinen, and Parnassia Bavo Groep.

Keywords: Evidence-based practice, implementation, recovery-oriented services.