This is evident from research by the GGD Amsterdam, in collaboration with mental health providers Arkin and GGZin Geest, into the care of people with a serious mental illness (EPA). EPA patients have a psychological disorder that requires long-term care and experiences problems in multiple areas of life. An estimated 10,500-13,000 EPA patients will live in Amsterdam in 2023. For the study, 685 Amsterdam residents with an EPA were interviewed using a structured questionnaire. 56 percent were interviewed a second time two years after the first interview to map their development. In addition, 30 relatives of Amsterdam residents were interviewed with EPA about their lives and the impact that being a loved one has on their lives. The interviews were conducted from 2018 to 2023.
EPA patients
In recent decades, treatment and support for EPA patients has increasingly shifted to outpatient care in the community. The emphasis is on participation, recovery and inclusion in society. The aim is for mental health patients to regain control over their lives. The support focuses on meaningful daytime activities, good health, a social network, entering into intimate relationships, being able to run your own household and self-care. In addition, the aim is for EPA patients to live independently in the neighborhood, in mutual harmony and socially embedded without stigma or discrimination. They must receive support from mental health care and collaborating partners in the social domain. This should also lead to fewer and shorter (forced) clinical psychiatric admissions.
Loneliness and stigma
But in practice it is difficult. Loneliness, stigma, discrimination and victimization and feelings of insecurity are still high among Amsterdam residents with an EPA. Although participation in work and daytime activities has increased since 2011, this has not led to a reduction in loneliness. Parties from the social domain still play a very limited role in the healthcare framework. Here lies an important opportunity for the social base to play a connecting role between Amsterdam residents with an EPA and with their neighbors.
Discontinuity of mental health care
Due to the scarcity of beds and staff in mental health care, there is a risk of discontinuity of care and the options for preventing escalations are limited. These escalations have a major impact on everyone involved, require a lot of time to recover from and a lot of care that cannot be spent otherwise. The research recommends further developing innovative (outpatient) options to reverse threatening escalations where possible, without unduly burdening loved ones.
Nuisance
EPA patients are regularly involved in incidents in which they cause nuisance to their local residents. In this study, 13 percent of the target group is identified by the Care and Residential Nuisance Reporting Points. Some also no longer have contact with specialist care or housing assistance or day care. The researchers therefore recommend organizing some form of ongoing contact in the event of deregistration due to the lack of treatment prospects or a request for help.
Physical complaints
Amsterdam residents with an EPA report many physical complaints and nicotine, alcohol and cannabis use is high. Attention to this from mental health care and accessibility of preventive services is necessary, according to the researchers.
Relatives and EPA patients
Furthermore, too much ends up on the plate of relatives of EPA patients. Many support tasks and responsibilities fall on loved ones for a long period of time, without taking sufficient account of their resilience. The informal network around people with an EPA is often small, which means that many loved ones are on their own in providing support. Despite the family policy of the Amsterdam mental health institutions and other care organizations, it seems difficult in practice to make decisions and provide care that also takes into account the (im)possibilities of loved ones. Mental health care, all other care organizations involved with people with an EPA, primary care, the social base and the municipality of Amsterdam therefore require more attention and tailor-made solutions for what loved ones need to stay healthy and involved.
