Position of service user, family and network
Overview of the Dutch perspective
The right of service users to exercise influence on the policy and practice of mental health and addiction services is in the Netherlands protected by law under the “Wet Medezeggenschap Cliënten Zorgsector” (Act of Client Participation in the Care Sector). The “cliëntenraad” or the client counsel is a respected and valuable member of Dutch care organisations and is consulted on a diverse range topics including, treatment, medication dispensing, safety and attitudes.
Through their own experience of illness and recovery clients develop their own story full with knowledge, insights and strategies of how to live a full life with a vulnerability for psychiatric disorders or addiction. It is possible for ex-service users to work in mental health and addiction services applying their unique experiences and stories of their own recovery process in diverse functions including advisor, recovery coach, personal support worker, trainer and recovery coordinator. These members of our care teams are known as by the generic name “ Ervaringsdeskundige” (in the UK “support time recovery worker”). They occupy often a unique place between the healthcare professional and the client. The perspective of an Ervaringsdeskundige is an important part of a team approach to the treatment of clients and the attention of the team for the family and network of the client.
Mental health and addiction care services have developed policy for the regulation of Ervaringsdeskundige. The joint target of the government and service providers is that the Ervaringsdeskundige should account for 5% of the total workforce in mental health and addiction care. Fifteen years ago the first vocational level course to train the Ervaringsdeskundige was developed. Although at this moment it is not compulsory for an Ervaringsdeskundige to achieve this qualification, most Ervaringsdeskundigen have followed some formal training and/or coaching.
The family and the network of the client do not have the same legal right to exercise influence in the care process as the client. However it is well understood in the Netherlands that family, friends, work colleagues and acquaintance (which we call “concerned allies”) have a vast knowledge about how the client functioned before they became ill. They also know the client as a person and not a patient, they understand and have been a part of their life outside the world of psychiatry and addictions and know what is important and life affirming for the client. This knowledge is vital for the recovery process. It is our belief that making bonds and engaging with family and concerned allies will greatly enhance the recovery process of the client.
The effect of mental health problems, addiction or a combination of both will have profound effects on the whole system surrounding the client. Rolls change within the system, for example spouses or children can take on a more parental roll. Listening to the stories of loved ones and understanding these changes will help greatly we believe in understanding and helping the client in her recovery. An example in the Netherlands of this viewpoint is the increasing number of RACT teams. RACT is a further evolution of the ACT model (The R meaning Resouces). In the RACT model clients set their own recovery goals and form a Regiegroup. Regigroup roughly translates in English into control group. The client chooses who is a member of this group (family, friends, pastor, neighbour, nurse, psychiatrist). This group forms the basis of the treatment and it’s aim is to support the client in achieving her recovery goals.
In the Netherlands clients, ex-clients, family and the network of patients are increasingly becoming partners of health care professionals in the recovery process.